Introduction: Lord Marks of Henley-on-Thames

Jonathan Clive Marks, Esquire, QC, having been created Baron Marks of Henley-on-Thames, of Henley-on-Thames in the County of Oxfordshire, was introduced and took the oath, supported by Lord Goodhart and Baroness Falkner of Margravine, and signed an undertaking to abide by the Code of Conduct.

Introduction: Lord Wasserman

Gordon Joshua Wasserman, Esquire, having been created Baron Wasserman, of Pimlico in the City of Westminster, was introduced and took the oath, supported by Lord Gavron and Lord Taverne, and signed an undertaking to abide by the Code of Conduct.

Introduction: Lord Fellowes of West Stafford

Julian Alexander Fellowes, Esquire, having been created Baron Fellowes of West Stafford, of West Stafford in the County of Dorset, was introduced and took the oath, supported by Lord Northbrook and Lord Marland, and signed an undertaking to abide by the Code of Conduct.

Herbal Medicines
	 — 
	Question

Lord Pearson of Rannoch: To ask Her Majesty's Government whether they will introduce statutory regulation of qualified and competent herbal medicine practitioners by the Health Professions Council at the earliest opportunity.

Lord Pearson of Rannoch: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as the unpaid patron of the Register of Chinese Herbal Medicine.

Earl Howe: My Lords, I can confirm that, while final decisions have yet to be taken, the Government are actively exploring the establishment of a statutory register for herbal practitioners. We are currently in discussion with the devolved Administrations, the Health Professions Council and the Complementary and Natural Healthcare Council about the feasibility of such a register and we expect to make an announcement shortly. I can assure the House that the Government are treating this issue as a priority.

Lord Pearson of Rannoch: My Lords, I am grateful to the noble Earl for that reply, from which it would appear that a definite decision has not yet been taken. Is he aware that some 5.8 million British people rely on herbal medicines for their well-being, that thousands of businesses and practitioners supply them and that none of this can continue as at present after 1 May if the Government do not meet the terms of the EU directive by then? Secondly, does the Minister agree that we owe this predicament entirely to our membership of the European Union-

Noble Lords: Oh!

Lord Pearson of Rannoch: We do, my Lords, we do. The EU has yet again ignored its own subsidiarity law to impose this diktat. Why cannot the British Government simply tell Brussels that we will decide this matter for ourselves?

Earl Howe: My Lords, on the noble Lord's first point, the Government are acutely aware of how important an issue this is for many millions of consumers. That is why we are working to reach what I hope will be a workable solution to ensure continuing access to popular and widely used products. I am sure that the House is well aware of the noble Lord's position as regards the European Union. I simply say that the medicines legislation framework is set at a Community level for a good reason. It exists both to protect public health in relation to medicines placed on the EU market and to ensure a level playing field for operators. But within that European framework there is flexibility for EU member states to operate national arrangements for the regulation of medicines in situations where an authorised health professional determines that an individual patient has special needs. We are considering the case for using that flexibility in relation to herbal medicines.

Lord Taverne: My Lords, do not most of the senior professional bodies, such as the MRC, the royal colleges and the Physiological Society, oppose registration because it gives a spurious authority to practices that are not based on science? Do the Government ignore these representations and listen instead to lobbyists such as the Prince of Wales, who believes in traditional medicine? Do they not recognise that medical practice is not like a piece of antique furniture that grows in value with age?

Earl Howe: My Lords, again I think that the House is well aware of the noble Lord's views, which I know are sincerely held, although personally I regret his comments about the Prince of Wales. However, I am sure that, with regard to herbal medicines, he will be aware that there is an international trade in sometimes poor-quality, unregulated and unlicensed herbal preparations. Some of these have been found to contain banned substances, heavy metals or pharmaceutical ingredients or substances from outside the UK that may not be subject to any form of regulation at all, so there is a public safety issue.

Baroness Pitkeathley: My Lords, does the noble Earl agree that, while statutory regulation has its place, regulation in healthcare and anything else should always be proportionate? Would he therefore endorse the concept of right-touch regulation, which is promoted by the Council for Healthcare Regulatory Excellence? I declare an interest as its chair.

Earl Howe: My Lords, I pay tribute to the noble Baroness for the work that she does and I entirely endorse the approach to regulation that she has outlined. Certainly, we need to adopt a targeted, risk-based approach to regulation.

Baroness Sharples: Is the noble Earl aware that I owe my good health to a great extent to herbal medicine?

Earl Howe: My Lords, that news is a source of pleasure to me and I am sure to the whole House.

The Countess of Mar: My Lords, I concur with the noble Baroness, Lady Sharples, because I do, too. How many people have died from adverse reactions to herbal medicines compared with the number of people who have died from adverse reactions to prescribed drugs?

Earl Howe: My Lords, I do not have the figures, but I am aware of a notorious case on the continent some years ago involving adulterated herbal medicines, which resulted in very serious illness for a number of women. Since 2005, the MHRA has identified 282 cases where products typically marketed as herbal or traditional remedies have been found to be adulterated with random quantities of pharmaceutical substances.

Lord Harris of Haringey: My Lords, would it not be more sensible for the noble Earl to present to the House the scientific and medical evidence that suggests that it is indeed sensible to provide any sort of regulatory framework? In the absence of that scientific evidence, would it not be simpler to make it very clear that it is illegal to make false, unfounded health claims in support of any substances and that, if they contain dangerous materials, the individuals promoting them should go to jail?

Earl Howe: That is precisely why we want to consider the possibility of a statutory register for practitioners, to make sure that those who prescribe unlicensed medicines that have been prepared by third parties are fit and proper people to do so. When we make the announcement, as I hope we will shortly, the rationale for it will be set out.

Baroness Browning: Is my noble friend aware that it is common practice in many GP practices to make recommendations for alternative medicines, such as tea tree oil for ingrowing toenails and arnica cream for bruises? In my former constituency, one GP practice actually grew its own herbs in the garden.

Earl Howe: My Lords, it is a long-standing practice and tradition in this country that medical professionals should be able to take it upon themselves to prescribe freely, as they see fit, in the interests of the particular patient in front of them.

Heritage: V&A Purchase Grant Fund
	 — 
	Question

Lord Howarth of Newport: To ask Her Majesty's Government what assessment they have made of the benefit to the nation of the Victoria and Albert Museum's purchase grant fund.

Baroness Rawlings: My Lords, the Government are fully aware that the Victoria and Albert Museum's purchase grant fund is a valuable means of helping the nation's non-national museums, specialist libraries and record centres to develop their collections. Through the acquisitions that it supports, the purchase grant fund helps to develop and strengthen the quality and standards of regional collections for the understanding and enjoyment of the public.

Lord Howarth of Newport: Is the noble Baroness aware that there will be widespread appreciation of her recognition that this modest fund-now only £900,000-which has been administered for the past 130 years by the Victoria and Albert, has been invaluable in enabling museums, libraries and archives whose main funding does not come from central government to make acquisitions for the public benefit, ranging from finds of archaeological treasure to modern literary manuscripts? Following the decision of the Government to abolish the Museums, Libraries and Archives Council, through which this funding has been channelled in recent years, will the noble Baroness give an assurance to the House that Ministers will continue to provide funding specifically to enable institutions across the regions of England and Wales to develop their collections? Will Ministers challenge philanthropic donors to double up the fund?

Baroness Rawlings: My Lords, we recognise that the noble Lord, Lord Howarth, has tirelessly campaigned for the preservation of the V&A purchase grant fund and I respect his knowledge and expertise in this area. I am very pleased that he has asked this Question as it gives Her Majesty's Government the chance to inform your Lordships that Arts Council England will continue the funding of the V&A purchase grant fund, once it assumes responsibility for the museums and library functions of the Museums, Libraries and Archives Council. Over the coming months, Arts Council England will be consulting those concerned before reaching a conclusion about the level of funding that will be made available to this grant for the next spending period. On the noble Lord's final point, the department would like to stimulate a culture of charitable giving and believes that there is scope for all public collections to strengthen their fundraising skills.

Baroness Gardner of Parkes: My Lords, is the Minister aware that, in the case of the V&A, the Australian Michael Hintze has given a huge donation that has enabled the museum to reopen a number of galleries? Does she agree that there may be plenty of other philanthropists who could follow suit, for the V&A and for other bodies?

Baroness Rawlings: My noble friend Lady Gardner is absolutely right that Mr Hintze has been remarkable in supporting the V&A and other institutions, and long may that continue. Philanthropic giving is something that the Secretary of State for Culture, Olympics, Media and Sport is pursuing with great vigour. Such giving is becoming more and more important, and I hope that he will look into it further.

Lord Myners: My Lords, in addition to the government purchase grant fund, another major source of new acquisitions for the V&A and other galleries is gifts that are allocated to them under the acceptance in lieu scheme in respect of inheritance tax. Is there any reason why this arrangement should be limited to inheritance tax? Could it not be extended to other forms of personal tax, with appropriate controls, including in particular the new tax on non-doms that the Government are currently considering?

Baroness Rawlings: My Lords, the noble Lord, Lord Myners, has for some time been pursuing this issue, which we are all very interested in. We know that the matter is under discussion and I hope that the Treasury will come to a decision that is favourable for the arts and museums very soon.

Lord Ryder of Wensum: My Lords, will my noble friend explain how transferring the purchasing policy of the V&A to the centralised and bureaucratic Arts Council is consistent with the devolving of powers that is apparently at the core of the big society?

Baroness Rawlings: I thank my noble friend Lord Ryder for bringing up the big society, which plays a key part in the agenda of the Department for Culture, Media and Sport. The DCMS will give Arts Council England responsibility for the purchase grant fund as part of its new responsibilities for the museum and library functions of the Museums, Libraries and Archives Council, so that the Arts Council can balance the interests of all the grants and make strategic funding decisions. This will save money and be more efficient.

Lord Harrison: Given that the origins of the V&A came in the aftermath of the 1851 London exhibition, which celebrated the best of British workmanship and design, will the noble Baroness say what is being done now to encourage museums such as the V&A and the Birmingham Museums and Art Gallery-which has a long association with business-to team up with business and industry to ensure that we promote the best of British design, especially in some of the new visual arts industries, to the benefit of a nation that wishes to recover economically?

Baroness Rawlings: The noble Lord, Lord Harrison, is absolutely right that the more that we combine those two areas, the better. Renaissance was another such project that his Government set up several years ago. I hope that there will be further work with renaissance to encourage more donations.

Lord Boswell of Aynho: My Lords, I declare an interest as a council member of the Friends of the National Libraries. I am delighted that my noble friend has made some positive statements in this difficult context. Will she bear in mind in particular the importance of small trusts like that, alongside the V&A purchase grant, in the area of archives and written artefacts, which are often overlooked in comparison with more politically attractive and visible parts of the visual arts? Will she personally ensure that there is adequate firepower to meet the need as and when items come for public sale that might otherwise be lost?

Baroness Rawlings: I thank my noble friend Lord Boswell for that question. His point about archives is very topical at the moment in the department. Over the coming months, Arts Council England will consult the people concerned about whether archives will continue to be eligible for the V&A purchase grant. It is possible that archives will continue to be eligible. The department is still in negotiations about which organisations will take responsibility for the Museums, Libraries and Archives Council's wider responsibility for archives. An announcement will be made shortly.

House of Lords: Conventions
	 — 
	Question

Viscount Montgomery of Alamein: To ask the Leader of the House what assessment he has made of the importance of behavioural and procedural conventions in the Chamber.

Lord Strathclyde: My Lords, self-regulation works only when Members act to support it. It puts the responsibility on us all as individual Members, in our political groups and on the Cross Benches, to ensure that the rules set out in the Companion and the conventions of the House are adhered to in spirit as well as in letter.

Viscount Montgomery of Alamein: My Lords, that is a very helpful reply, but does the noble Lord not agree that too many bad habits have been brought from the other place and are causing a problem, such as interrupting in timed debates and not giving way at Question Time? In a self-regulating House, these are extremely important and valuable parts of our procedure.

Lord Strathclyde: My Lords, the noble Viscount is the living embodiment of courtesy and good practice in this House and many of us would do well to emulate his behaviour. He is quite right that refusing to give way at Question Time is at odds with the usual courtesies extended in this House and that repeated interruptions are an aspect of behaviour that some argue have infiltrated from another place, which we should not be seeking to emulate. However, I think that there is general good will across the House to maintain some of the very good behaviour in the House when it is at its best. The best way of doing that is to follow the example of those who emulate that practice.

Lord Barnett: Is not the bigger problem ministerial behaviour? Is the noble Lord aware that some Ministers do not seem to understand government policy on transparency? I give one small example. I asked a very simple Question recently on whether the Treasury would supply information on what its representative on the Monetary Policy Committee of the Bank of England had said about interest rates and quantitative easing. The Answer that I got was that it was a matter for the Monetary Policy Committee to publish, but Ministers know that it never does. Will the noble Lord perhaps issue guidance to Ministers-some of them, not all-on government policy on transparency?

Lord Strathclyde: My Lords, I do not agree that that is a bigger problem than concerns about the conventions and rules of this House. Ministers in the House of Lords have standing instructions to treat Back-Benchers from all sides of the House with utmost courtesy and to be as transparent as possible. If the noble Lord received an Answer from one of our Ministers that he did not like, that was still the right Answer to give.

Lord Dholakia: My Lords, the noble Viscount makes the important point that since the introduction of a number of colleagues from the other place the behaviour pattern of this House has changed. In light of that, will the noble Lord consider the role of the Lord Speaker to ensure that such rules and regulations are not flouted?

Lord Strathclyde: My Lords, I know that some in this House would wish to see a greater role for the Chair, notably at Question Time, and no doubt they will have made representations to the Leader's Group, chaired by my noble friend Lord Goodlad. My view is that our existing practice, whereby it is the responsibility of the whole House and all Members present to draw attention to breaches of order and failures to observe custom, continues to serve us well, as the Question asked by the noble Viscount, Lord Montgomery, today illustrates.

Lady Saltoun of Abernethy: My Lords, does the noble Lord the Leader of the House remember that about 30 years ago, when he and I first became Members of this House, Baroness Hylton-Foster was Convenor of the Cross-Bench Peers. If any new boy or girl in her flock transgressed, she took them aside later and came down on them like a ton of bricks. Would it not be a good idea if the leaders of the various parties were to do that today?

Lord Strathclyde: My Lords, I agree with the noble Lady. I am sure that the current Convenor is as firm with her flock as was the noble Baroness 20 or 30 years ago. I point out that in 1998 the noble Baroness, Lady Hilton of Eggardon, wrote a report that is worth rereading. I have suggested to the Clerk of the Parliaments that he should consider whether aspects of it should be republished and given to all noble Lords in an as easy-to-follow format as possible.

Baroness Royall of Blaisdon: My Lords, like all noble Lords, I recognise the importance of behavioural and procedural conventions and, like the noble Lord, I believe that there is good will on all sides of the House. If any noble Lords sitting on my Benches have occasionally not adhered to behavioural conventions in the Chamber, the responsibility must lie with me as leader of the Labour group. Mea culpa-I will try to do better. Does the noble Lord the Leader of the House agree that one reason why we adhere to certain behavioural and procedural conventions is precisely to maintain the difference between this House and the other place? We are one Parliament with two Houses and we celebrate the distinctive characteristics of this House.

Lord Strathclyde: My Lords, I very much welcome what the Leader of the Opposition has said. The whole House should recognise what she has said and the support that she has given to the current conventions and the rules as laid out in the Companion.

Lord Grocott: My Lords-

Lord Soley: My Lords-

Noble Lords: Next Question.

Charities: VAT
	 — 
	Question

Baroness Royall of Blaisdon: To ask Her Majesty's Government what steps they will take to allow Sue Ryder Care and other charities to recover VAT in the same way as other bodies providing public services.

Lord Sassoon: My Lords, although local authorities, government departments, the NHS and certain other public bodies incur irrecoverable VAT, just as many charities do, on certain of their activities, it is the case that a small number of VAT refund schemes operate in the public sector. Charities already benefit from a range of tax reliefs and it is not proposed to introduce any general VAT recovery scheme for the sector.

Baroness Royall of Blaisdon: My Lords, I thank the noble Lord for his Answer and for the information that he provides. I understand that this is a long-standing problem, but it has been exacerbated by the rise in VAT to 20 per cent. Does the noble Lord agree that in the context of charities such as the excellent Sue Ryder Care, whose centre in Leckhampton I know well, being asked to provide additional public services as part of the big society initiative, some solution should be found to ensure that there is a level playing field between charities, local authorities and the NHS, when all are delivering the same or similar public services?

Lord Sassoon: My Lords, I certainly take the opportunity to commend the work that Sue Ryder and many other charities do. They are facing a tough time, as are many parts of society. We find ourselves in the regrettable situation that charities will be bearing the additional VAT. The whole of society is bearing the burden of the difficult decisions on deficit reduction. The charitable sector of course benefits from significant VAT and other tax reductions and exemptions to the tune of £3 billion a year. The question of a level playing field is important, but it is of a level playing field with the public sector, which itself cannot recover all its VAT. For example, in the National Health Service, only about 20 per cent of the irrecoverable VAT is refunded, and only on outsourced services. Equally, we must remember that there are commercial providers of social care and other services who would be disadvantaged if there was a special scheme for charities.

The Countess of Mar: My Lords, is it not rather unfair to people who donate to charities from their taxed income that, in effect, the income is being taxed twice? They feel that they are doing a good deed and can be rather unhappy that the money is going into the Treasury coffers.

Lord Sassoon: I reiterate that it is important that we recognise that there are significant benefits within the VAT system for charities and that we have exemptions from the general EU rules on VAT that are not enjoyed by charities anywhere else in Europe. It is also the case that other proposals for increases in taxes would have hit charities significantly higher. If, for example, the previous Government's proposals on increases in national insurance contributions had not been reversed by this Government, there would have been a significantly higher burden on charities than the regrettable increase in the level of irrecoverable VAT. I do not think that we should take this issue in total isolation.

Lord Lawson of Blaby: Does the Minister agree with the principle that I set out when I was Chancellor that if one wishes to encourage charities through the tax system, which I approve of, it should be through concessions for charitable giving, not through relieving particular charities from tax?

Lord Sassoon: I agree that tax relief related to charitable giving is a critical part of the piece. Indeed, gift aid is running at some £1 billion a year and is a very successful and important scheme.

Lord Morris of Manchester: My Lords, the Minister will have seen my Question on the Order Paper on this important issue. Can he say now how much was raised from charities in irrecoverable taxation in the last year for which figures are available? What kind of inducement is it to charitable giving when moneys intended for deprived and often severely disabled children go instead to the Billy Bunters of the Treasury?

Lord Sassoon: My Lords, the increase in taxation from charities, as from other parts of hard-pressed society, including working families and businesses, is regrettably necessary to reduce the enormous deficit that the country has to bear. That is the regrettable state of affairs. It is not easy to consider where the burden should fall. Charities are, in this respect, sharing part of the burden. As I said, there are other tax proposals that the previous Government had that would have hit the charity sector, in this respect, harder. Charities get tax relief of the order of £3 billion through VAT, gift aid and other provisions.

Lord Eatwell: My Lords, I declare an interest as the master of a Cambridge college that is registered with the Charity Commission. I am sure that all noble Lords will know that changes in fiscal policy, with respect to both irrecoverable VAT and the fall in the standard rate of taxation, which has reduced the return on gift aid, have made considerable inroads into the support that government has in the past provided for charities through the fiscal system. We on this side quite understand that these are unintended consequences of fiscal policy, but we do not accept the negativism and complacency that the noble Lord has displayed. There is an easy answer to this question. He usually asks for policies because the Government cannot think them up themselves, so I will give him one: why are charities not allowed to make a return to the Treasury of the VAT paid, so that the Treasury can then apply a clear discount for charities, thus making its revenue from charities transparent, not disguised as it is at present?

Lord Sassoon: My Lords, we look at charitable-related VAT schemes and have a number under consideration at the moment. I am always happy to look at schemes. I stress that the Government have made special recognition of the importance of the charitable sector through the tough spending review. The Office for Civil Society will be spending around £470 million on programmes supporting the voluntary and community sector over the spending review period. The big society bank will have a further contribution to make and my right honourable friend the Chancellor announced a £100 million transition fund for those voluntary and community sector organisations that are affected by spending reductions. The Government absolutely recognise the support that is needed for this sector.

Baroness Howarth of Breckland: My Lords-

Leader's Group on Members Leaving the House: Final Report
	 — 
	Announcement

Lord Strathclyde: My Lords, I rise to inform your Lordships that today I have published the report of the Leader's Group on Members leaving the House. The Leader's Group, chaired most ably by my noble friend Lord Hunt of Wirral, was set up in July last year to identify options for allowing Members to leave the House of Lords permanently. In producing the report, my noble friend Lord Hunt and the group took time and care in consulting widely in your Lordships' House. They produced an interim report in November and many noble Lords took the opportunity to contribute to that debate.
	The final report, published this morning, makes a number of very sensible and businesslike recommendations. The group proposes that arrangements for leave of absence should be immediately strengthened to encourage those who, for whatever reason, are unable to play a full part in the work of the House to step down from active membership. The group also recommends that a scheme should be established to allow Members to give notice of their intention to retire from membership of the House permanently. I am delighted that the report endorses the Government's view that any such moves should not create additional costs to the taxpayer.
	I now intend to ask the Procedure Committee to come forward with proposals to put these recommendations into effect, and I will put the resulting proposals before your Lordships' House in due course. I am sure that I speak for all Members of your Lordships' House in expressing my thanks to the six members of the Leader's Group for producing an excellent report, and I urge all noble Lords to read it and consider its recommendations.

Postal Services Bill
	 — 
	First Reading

The Bill was brought from the Commons, read a first time and ordered to be printed.

Breaks for Carers of Disabled Children Regulations 2011
	 — 
	Motion to Refer to Grand Committee

Moved by Lord Strathclyde
	That the draft regulations be referred to a Grand Committee.
	Motion agreed.

Turkey
	 — 
	Debate

Moved by Baroness Hussein-Ece
	To call attention to the economic and strategic role of Turkey in Europe and the Middle East; and to move for papers.

Baroness Hussein-Ece: My Lords, modern Turkey is a dynamic secular nation with a strong civil society. It is a country burning for change to reform further its democratic institutions. On 12 September last year, the 30th anniversary of the military coup in 1980, the Turkish Government held a referendum to change the constitution, which was drafted under military rule in the early 1980s. Their objective was to bring the constitution more in line with European Union standards, with more than 20 amendments being presented to voters. Fifty-eight per cent of Turks voted in favour of the amendments, which would curb the military's power and reshape the judiciary. The turnout was 77 per cent and 22 million Turkish voters supported these changes. The main opposition party and other nationalists groups were opposed to these changes, and it is fair to say that this has led to some polarisation of public opinion.
	The EU has welcomed the successful referendum on the package of constitutional amendments, saying the results brought Turkey a step closer to its European objective. The measures will make the Turkish military more accountable to civilian courts, will end the immunity from prosecution granted to leaders of the last coup 30 years ago, and will give the Turkish Parliament the power to appoint several judges. In addition, the reforms will expand the social rights of civil servants as well as strengthen gender equality and child protection.
	Mr Egemen Bagis, Turkey's Minister for European Union Affairs and chief negotiator with the EU, vowed in an interview that his country would continue with the process of democratic reform. He said:
	"Having taken this step, we are going to continue with reforms, and we will take the necessary first steps so that Turkey becomes a country that answers to the European criteria, so that the people of Turkey benefit from a high standard of living".
	Prime Minister Erdogan has pledged a complete rewrite of the 1980 constitution. This is expected to happen after the general election, which is due this summer.
	All these events, however, should not lead us to hastily conclude that, as a result of the referendum on constitutional reform, Turkey is automatically closer to the goal of EU membership any time soon. For 40 years Turkey was critical to Europe in the Cold War, guarding its eastern flank. As a result Turkey suffered its own cold war in its lack of development during the 1960s and 1970s, and isolation from the outside world. As a child I spent most of my school holidays staying with family in Turkey. I recall my parents driving across Europe to Turkey and packing cherished western goods such as toiletries and other consumables, which were highly sought-after gifts that were not available in Turkey. Turkey-EU relations are at one of the lowest points in years. In Turkey and even in westernised Istanbul the move towards EU membership has declined, given that there is so little that is positive to report, together with growing cynicism and disaffection towards the EU among the Turkish people.
	What are we to make of a statement made only last week by the Austrian Foreign Minister, Michael Spindelegger, who suggested that Turkey's ongoing negotiations for European Union membership will not be completed before 2024? I share the view expressed by others that by shutting the door the EU is merely strengthening the arguments posed by nationalists and extremists, and further damaging the reform process in Turkey by weakening the arguments of those within the Government who are pushing forward with the reform agenda.
	The danger is that it could easily derail these altogether. Offers to accept some form of EU privileged partnership have understandably been rejected. The question also has to be put: just what message is the EU passing to Turkey and to the wider Islamic world beyond that? Germany, with a population of more than 3 million ethnic Turks, is hostile and continues to be unhelpful, along with France. Orhan Pamuk, the Turkish Nobel Prize winning writer, wrote in a recent essay that,
	"successive generations of the Turkish elite have faithfully taken France as their model, drawing on its understanding of secularism and following its lead on education, literature and art ... so to have France emerge over the past five years as the country most vehemently opposed to the idea of Turkey in Europe has been hugely heartbreaking and disillusioning".
	This Government, like the previous Government, are committed supporters of Turkey and its European Union membership. Last July, David Cameron, on his first visit to Turkey as Prime Minister, said that he had gone there,
	"because Turkey is vital for our economy, vital for our security and vital for our politics and our diplomacy".
	He went on to say:
	"I believe it is just wrong to say that Turkey can guard the camp but not be allowed to sit in the tent".
	Turkey's Foreign Minister, Ahmet Davutoglu, talks of EU membership as "still a rational choice" but complains, justifiably, about double standards and prejudices. Mr Egemen Bagis says that the word on the Istanbul street is resentful. He said:
	"My constituents say, 'We didn't need the EU in order to triple our national income as we have done. So why bother?'"
	In 2007-08, the House of Commons Business and Enterprise Committee's eighth special report on Turkey, ironically entitled, Keeping the Door Wide Open, said:
	"All too often it is suggested that Turkey does not 'belong' in the EU. However, Turkey has long had a close relationship with the EU and the EEC before it, it is a member of NATO and the OECD, and although the majority of the population is Muslim, it is a secular democracy. We agree with the Government that accession offers strategic benefits to both parties".
	Since this report, the Turkish economy has expanded rapidly. There have been far-reaching structural reforms. There are signs of a new and more honest attitude to the Kurds, with attempts made by the Turkish Government after the referendum to revive dialogue with Kurdish political leaders that go in the right direction. On the Armenian issue, Turkey was one of the first countries to recognise Armenian independence in 1991 and is keen to normalise its relations with Armenia with recent developments and protocols. There is still a long way to go, but that is positive and welcome.
	The Cyprus problem remains a major stumbling block, and since 2006 the EU council has frozen eight of the 35 policy chapters because of Turkey's refusal to open its ports and airspace to Greek Cypriot shipping and aircraft. Four more chapters have been blocked by France and Cyprus has blocked six, including the energy chapter. There are only three chapters left to be opened. It seems that in the absence of any will to reach a breakthrough, Cyprus may well slide towards formal partition if a make-or-break meeting of Greek and Turkish Cypriot leaders at the UN this month fails to find a solution. Interestingly, the Republic of Cyprus seems to believe that it is Turkey that "holds the key" to any solution. In my view it is not taking enough responsibility.
	I believe the Annan plan to bring a lasting settlement in 2004 was a huge missed opportunity. In the referendum, 65 per cent of Turkish Cypriots voted in favour, with 76 per cent of Greek Cypriots rejecting the plan. Many of us were left bitterly disappointed at this missed opportunity for reunification when the Greek Cypriots voted to reject it and, in effect, voted for the status quo; and were thus rewarded by becoming a member of the EU. The resolution of the Parliamentary Assembly of the Council of Europe in 2004,
	"pays tribute to the Turkish Cypriots, who supported the Annan plan by an overwhelming majority, thus opting for a future in Europe. The international community, and in particular the Council of Europe and the European Union, cannot ignore or betray the expressed desire of the majority of Turkish Cypriots for greater openness and should take rapid and appropriate steps to encourage it. The Turkish Cypriots' international isolation must cease".
	Almost seven years on, this has yet to be honoured. For a country that for many years has been on the periphery of Europe, and is a bridge between Europe and Asia, Turkey will play a bigger role in 2011. It will be Europe's fastest-growing sizeable economy for the second year running; growth in 2010 was close to 6 per cent. Turkey's presence in the United Kingdom is significant: £380 million has been invested by Turkish companies in the UK; more than 3,000 Turkish students attend UK universities; the Turkish-speaking community in Britain is approaching 500,000 people; and the UK is the second biggest export market for Turkey. The number of UK tourists visiting Turkey last year exceeded 2.7 million, a 60 per cent increase in the past four years, UK direct investment in Turkey has increased, and currently around 2,200 British companies operate in Turkey with an investment value of $4 billion. More than 20,000 UK citizens have bought property in Turkey, and there is a large settled British community living and working in Turkey. The annual trade volume between Turkey and the UK reached $9 billion in 2009.
	Turkey is a rapidly developing country with a large domestic market of 72 million people and a springboard to markets of central Asia and the Middle East. It also has a young growing population, an expanding middle class, and significant opportunities for UK companies in a variety of sectors. Turkey's central strategic location at the point where East meets West and its ability to reach and serve its surroundings-Europe, central Asia and the Middle East-are key assets. Turkey has historical, cultural and linguistic links with more than 1 billion people in its neighbourhood, where Turkey's market penetration is strong, particularly in consumer goods.
	Turkey also has strategic importance when it comes to the vital issue of energy. It is one of the most viable routes for the safe and uninterrupted flow of natural gas and oil resources to the West in what is a very volatile region. In this respect, Turkey is key in ensuring energy security through several projects such as the East-West energy corridor, with its pipeline projects linking the Caucasus and central Asia to Europe.
	Turkey's recent focus on the Middle East does not, however, mean that Turkey is about to turn its back on the West. Nor is the shift evidence of the creeping Islamisation of Turkish foreign policy, as some critics claim. After decades of passivity, Turkey is now emerging as an important diplomatic player in the Middle East. Turkey has pursued an active foreign policy. Over the past few years, Ankara has established close ties with Iran and Syria and adopted a more proactive approach toward the Palestinians' grievances.
	Since Israeli commandos boarded the Turkish-owned, Gaza-bound aid vessel, "Mavi Marmara", back in May last year, killing nine Turkish national civilians-some shot at point blank range-relations between Israel and Ankara have been damaged. The collapse of the strategic relationship with Turkey is bad news for Israel, which until the events in May last year relied on Turkey as its strongest ally in the region.
	The United Nations Human Rights Council's report into the incident makes damning reading. This has been compounded by the absence of any apology from Israel, which has caused huge anger amongst the Turkish civilian population. The mood in the EU against Turkey has changed rapidly over the last few years, while at the same time there has been a decline in the EU's credibility from outside the EU. As the European public and European politicians have become consumed by doubts about enlargement, immigration and their own economic security, the position towards Turkey has hardened. We cannot deny that, given that it is a predominantly Muslim country, Islamophobia is seen as major influence; they are not welcome in the Christian club.
	The Turkish Prime Minister, Mr Erdogan, said last week in a meeting with the Greek Prime Minister:
	"If the EU does not want to accept Turkey as a full member, it is obliged to announce it because our patience has its limits".
	This sentiment is now becoming widespread across Turkey. People are rightly calling for an honest approach to Turkey's chances of EU accession. Last November, President Gul of Turkey was awarded the 2010 Chatham House Prize, presented by Her Majesty the Queen. I was privileged to be present. President Gul was recognised as a significant figure in reconciliation and moderation within Turkey and internationally, and a driving force behind many of the positive steps that Turkey has taken in recent years. Mr Gul has worked to deepen Turkey's traditional ties with the Middle East, to mediate between the fractious groups in Iraq, to bring together the Afghan and Pakistani leaderships to try to resolve disputes in 2009 and to anchor Turkey in the European Union. Not so long ago, an award like this would have been quite unthinkable.
	To conclude, Turkey needs to be at the centre of Europe for the long-term security, peace, stability of Turkey, the EU and the region. It can either be a bridge between East and West or it can become a fault line. The continuing reforms in Turkey need our active support and encouragement. I ask my noble friend the Minister to give his views on this. I thank in advance all noble Lords who will take part in this debate and look forward to hearing all contributions.

Lord Trimble: My Lords, I congratulate the noble Baroness, Lady Hussein-Ece, on having secured this debate on such an important topic-and perhaps I may follow that with an apology. She made some references to the maritime incident involving the MV "Mavi Marmara" and other vessels. Unfortunately I will not say anything-I do not feel able to say anything-on that subject because, as noble Lords may know, I am connected with the Israeli government inquiry into that matter. So it would be quite inappropriate for me to say anything other than that I hope we will see a report from that committee within the next few weeks. That might deal with some of the points that she raised. I cannot go further than that.
	As I said at the outset, this is an important debate, and I congratulate the noble Baroness on drawing attention to this matter. As she says, Turkey is important. It is important because of its size, because of its economy and because of the growth in its population and its economy, the latter having been particularly notable over recent years. It is also important in terms of its geopolitical situation and its relationship with the European Union. As the noble Baroness says, we have long been very supportive of the Turkish application to join the European Union. I have always seen that as a hugely important step forward, if it can be brought to fruition.
	As the noble Baroness says, through NATO Turkey has contributed significantly to European security over the years and has achieved a degree of integration into a number of European institutions. Turkey is also a hugely important bridge between Europe and Asia and between the largely Christianised West and the Islamic East and Middle East. Of course people in the latter community will look to see how Europe deals with Turkey as an indicator in that respect, and perhaps I may remark parenthetically on that point. We tend to forget that one of the main drivers of the radicalisation of Muslim minorities in this and other European countries was originally what happened in Bosnia, when Muslim minorities in our own states saw what happened to the Muslim minority in the Balkans, and the palpable failure of Europe to protect it. We tend to forget that that was a significant factor in radicalisation long before anything else came over the horizon. That is a parenthetical remark which I will not follow further at the moment.
	One of the problems with being a bridge is that it involves a degree of ambiguity. Bridges link the two communities, or two elements, that we have mentioned in terms of Europe and Asia, Christians and Muslims; but the question arises of which way the bridge is balanced and which way it looks. There we have ambiguities which unfortunately are not being resolved in a particularly helpful way. The existence of the Turkish application to join the European Union, and the way in which Europe has responded to it, is bringing those ambiguities to the fore. The noble Baroness referred to the way that so many of the chapters in Turkey's application are being blocked, some by the European Commission, some by reference to the problems over Cyprus, some by Cyprus itself, and some by the French. She linked that to the negative statements on this issue that have come from the French and the Germans; and we all know that within the European Union, the French and the Germans tend to be the arbiters of policy. If they are negative, what prospect is there for this negotiation to come to fruition, and what impact will that have on Turkey?
	Indeed, what impact has it already had on Turkey? Again we see ambiguities in that what has been happening in Turkey over the past few years can be seen as a turning away from Europe and towards other directions. Let us consider the referendum which was held last year and the constitutional changes which flowed from it. These can be seen, as the noble Baroness said, as a way in which Turkey is accepting the democratic standards that exist in the European Union-which is a positive-but they can also be seen as the AK Government taking further steps to dismantle the elements of the Kemalist state. It is the Kemalist state that is responsible for the degree of secularisation that exists in Turkish society. If the Kemalist state is being dismantled, what is the future for secularism in Turkey, particularly as the AKP is to some extent an Islamic party. The AKP portrays itself as a moderate Islamic party and barrier against more extreme Islamic elements, but again these are matters of interpretation. That is what I mean about ambiguities there.
	Even in terms of Turkey's approach to policy elsewhere in the Middle East, there are ambiguities. One does not object to Turkey being a major player in the Middle East since its location, size and economic position points in that direction, and it is quite natural for Turkey to look to the areas of influence that are available to it there, but again we see elements of ambiguity. The noble Baroness referred to relations between Turkey and Israel. One positive aspect is that, only a year or so ago, the Turkish Government brokered talks between Israel and Syria. At the time it seemed a positive development, and we are delighted that the Turkish Government facilitated the indirect talks that took place. It seemed a positive step on the part of both the Israelis and the Turkish Government, and, one hopes, of the Syrians. The talks did not come to fruition but the fact that they occurred is worth noting. In that respect, Turkey was assisting the political process in the Middle East. On the other hand, when we look at Turkey's position with regard to Palestinian grievances, Turkey has tended to align itself with Hamas rather than with the Palestinian Authority. That is not going to advance the Middle East political process at all, so there is an ambiguity there.
	There is even an ambiguity in another direction. In recent years, Turkish diplomats have reached out towards Armenia, which is a sensitive issue. In a recent visit to the city of Kars, which once had a large Armenian community that was annihilated in 1915, there is some element of reconciliation through the erection of a large statue to humanity. However, Mr Erdogan has made negative comments about it and called for it to be demolished, which leaves open questions about what his position is with regard to that area too.
	So we see ambiguities which we hope will be resolved positively. We hope that the position with regard to Europe can be resolved positively, although the outlook is not terribly bright at the moment.

Lord Wallace of Saltaire: My Lords, we are very short of time in this debate. If all Members could end their speech when the sixth minute comes up on the Annunciator, we would be very grateful.

Lord Bhattacharyya: My Lords, I congratulate the noble Baroness, Lady Hussein-Ece, on securing this vital debate. I am pleased to declare that WMG at the University of Warwick, of which I am the director, admits many Turkish students on bursaries that we fund ourselves. We have a very close relationship with leading Turkish universities and businesses, such as the private university, Sabanci University in Istanbul, which I had the pleasure of visiting last year.
	Walking the streets of Istanbul, you see how the western world found its axis there. Think of Belisarius, who reconquered Rome in the name of the Roman Empire, or of the great Ottoman scientists like Ali Qushji.
	Our relationship with Turkey should be based on shared interests. Turkey's national interest lies in meeting its citizen's hunger for prosperity. Our interest lies in benefiting from its future growth. The first key to Turkey's prosperity is, of course, joining the European Union. That in turn relies on many things, especially solving the problems of Cyprus. I know that many noble Lords will address those issues today. I wish to focus on the economy, so I merely observe that it is in the interests of all of us to find an amicable way forward. I understand that Turkish leaders in Nicosia are keen for a solution as well.
	The second key to Turkey's growth is to become the manufacturing powerhouse of the Near East. We should welcome that. If we want to prevent the Islamic world moving to fundamentalism, we need a successful and educated Turkey, for itself and as an inspiration to the people of neighbours such as Iran. After all, who would rather live in a closed city than an open, vibrant one, such as Istanbul? We should have confidence in the attractions of the free, open, prosperous society.
	Of course, the path to prosperity can be a hard road. Turkey suffered greatly from the global economic crisis. Its peak to trough GDP decline was 14 per cent, the highest in the OECD. To take one example, the automotive sector, on which I am very keen, was responsible for a fifth of Turkey's export earnings in 2008. In 2009, those exports fell by a quarter.
	Turkish leaders see that their position is exposed to external shocks. The economy is recovering strongly-over 6 per cent last year, as the noble Baroness mentioned-but they know that they must diversify to achieve stable growth. The first element of their strategy is supporting innovation. In 2008, Turkish business expenditure on R&D was less than a quarter of the OECD average.
	I recently discussed that with the Minister for Foreign Trade, Zafar Caglayan. There is huge room for growth in the region, but it requires innovation. Take the automotive sector again. There are only 100 vehicles per 1,000 people in Turkey. In neighbouring countries, the number is lower still, though people are getting wealthier, so developing durable, low-fuel consumption vehicles will be crucial to meeting consumer needs. Furthermore, Turkey may move away from the textile trade, on which its economy has depended, to other areas.
	That is why Turkey is now focused on increasing R&D. Facilities that employ at least 50 technicians get around half of their investment costs back. Ten of Turkey's 13 vehicle manufacturers are already taking advantage of that support. This is a major opportunity for British business. We have world-leading innovation in the automotive sector to offer.
	Next, Turkey has a pressing need to improve its human capital, especially in science, skills, and other education. In the 2009 international education ratings, PISA, Turkey showed some of the biggest improvements surveyed, but that success needs to extend to the graduate and vocational level. The challenge is being taken seriously.
	When I visited one of the biggest football clubs in Turkey, Fenerbahce, I found that it planned to establish its own university and asked us to help. Not many British clubs would do that.
	Britain's university science sector is excellent. If we offer partnership with Turkish institutions now, we will reap rewards when expanding businesses look to the UK for support. After all, Turkey is not short of investment for entrepreneurs. A lot of the new universities are coming out of private capital.
	The flow of money into Turkey has led the central bank to take the unusual step of cutting interest rates to cool the economy and lowerinflation. As the EU builds a fence across the border with Turkey to keep out immigrants, Turkey is building fences to keep money from flowing the other way. We should follow that money. If we offer help now, we can be partners with Turkey as it develops and take advantage of the investment available to businesses operating there. If we spurn this chance, others will seek to take that place. I hope we do not betray our own interests by neglecting those of our allies. I trust that this Government, like the last, will see the great opportunity that lies ahead in the Near East.

Lord Chidgey: My Lords, I, too, congratulate my colleague and noble friend Lady Hussein-Ece on a stunning opening speech in this important debate. She covered the issues so completely and so well that we are going to spend our time underlining the points she raised.
	It might be the case that political developments within Turkey over the past decade or so have not been as some may have wished and that the direction of travel of Turkey's foreign policy has caused some unease in some quarters. That is all the more reason why we should steadfastly engage with Turkey on the broadest front to secure that country's rightful place on the eastern flank of Europe as a bridge to advance and defend our common interest in the Middle East, the "Stans" and beyond, as the noble Baroness and the noble Lord, Lord Trimble, mentioned.
	It would be crass and probably naïve for Europe to turn her back on Turkey because negotiations to join the EU have become exasperatingly entangled or the shape and progress of Turkey's development as a secular republic has been less than ideal. Beyond the obligations of the acquis communautaire, there is no "one size fits all" for the EU and nor should there be. Our excellent Library note provided us with background reading for this debate that sets out the key economic and strategic issues that irrefutably bind Europe and Turkey. It is primarily political, cultural and religion issues that keep us apart.
	The difficulties facing Turkey in meeting the criteria to become a full member of the European Union seem to grow rather than diminish. I would say that 2010 was a stagnant year for negotiations on the chapters of the acquis. There is clearly a long way to go before accession negotiation talks can near conclusion with the EU Copenhagen criteria fully met. That is assuming that Turkey does not lose interest in the EU and concentrates instead on cultivating already burgeoning economic growth and trade with its eastern and southern neighbours. Turkey's annual trade with the Arab world now stands at some $30 billion, compared to less than $2 billion a decade ago. Meanwhile, in 2008, the volume of Turkey's trade with the EU dropped below 50 per cent for the first time.
	Turkey has not as yet resiled from its stated ambition to become a member of the EU. What matters is that the membership process continues through the mutual efforts of Ankara and Brussels. According to the Belgian Prime Minister, Yves Leterme, speaking to the Sunday Zaman last week:
	"Some people in Turkey are asking whether Turkey's future is in the EU or not; however, this is a question for Turkey itself. Europe has accepted Turkey's candidacy, and the process is going on ... Today, it is a fact that many Muslims live in Europe. The EU continent is dominated by Christian customs. A modern and contemporary Islam can definitely serve as a reference for Europeans".
	Given the present stalemate in the accession process, where do the Government stand on the points made by Mr Leterme in connection with Turkey's inclusion in the EU?
	It seems that increasing Turkish frustration with the EU and the United States' perceived indifference to accession has persuaded Foreign Minister Ahmet Davutoglu to begin a "zero problems with neighbours" approach to regional foreign policy relations. It appears Turkey's new foreign policy concept is to emerge as a regional hegemon through economic presence, interdependence and an increasingly influential diplomatic role. To this end Turkey has promoted visa-free travel within the former greater Syrian provinces of the Ottoman Empire, including Lebanon, Syria and Jordan. It has moved closer to Russia, China, Iran and the neighbouring Muslim states to the east. Russia became Turkey's largest trading partner in 2008, and in 2010 an agreement was signed to construct a $50 billion nuclear plant near Mersin on Turkey's southern coast. That burgeoning economic relationship has facilitated a no-visa treaty between Turkey and Russia, bringing the two countries even closer together.
	Turkey's present position can perhaps best be understood by the remarks of Foreign Minister Ahmet Davutoglu in his keynote address to ambassadors meeting in Ankara on 3 January. He told the diplomatic corps that from now on Turkey will be at the forefront of restructuring the world order, taking the role of "game setter" and that of a "wise country". Turkish diplomacy will be active in diagnosing regional and global issues and in developing appropriate alternative responses. Ankara will make its voice heard and will make an impact.
	Commentators within Turkey see this concept as an end product of its emergence as a "rising power", able to expand its sphere of influence in the region and the globe. Turkey is rapidly growing and developing but also faces serious problems internally, as well as externally. Analysts in Turkey believe that before rushing towards "global power" status, it might be better to prioritise funding solutions to these problems. Leaving the Kurdish question to one side, there are a wide range of internal political, economic and social issues that have yet to be resolved within the country. Externally, the issues of Cyprus and Armenia, and of relations with Israel and the EU, fill the foreign policy agenda.
	The considered view of Sami Kohen, for example, writing in the Hurriyet-the daily Turkish English-language paper-is that these problems should not prevent Turkey from pursuing an active foreign policy agenda. It is, however, unrealistic to spend more time and energy, and resources, on external issues while there are still so many problems to deal with in the country. In short, the vision of "global opening" gives a new focus for Turkish diplomacy, but one that should be followed with balanced and prudent caution.

Lord Hannay of Chiswick: My Lords, Turkey, which in the last quarter of the 20th century had often seemed set to requalify for the title of,
	"the sick man of Europe",
	has now gained its place in the new G20 group-the primary co-ordinator of global economic issues-and is developing a new, active foreign policy in place of its vulnerable immobility in the front line of the Cold War. The case, therefore, for us to take stock of this major strategic shift and to try to draw some conclusions for our own policies in Europe and beyond is therefore compelling, and a reason for congratulating the noble Baroness, Lady Hussein-Ece, on having provided the opportunity for this House to do so.
	I suggest that the first thing to be clear about is that Turkey's enviable economic growth record, barely dented by the recession which began in 2008, is good news for other European countries, including Britain. It provides a major market for our capital and consumer goods and an attractive pole for foreign investment. The fact that the European Union already has a customs union with Turkey has done much to create and now underpin this advantage, but the fact that Turkey is growing considerably faster than other European countries is more than that. It means that the frequently evoked nightmare of excessive Turkish emigration to the rest of Europe in the context of Turkey as a member of the European Union becomes steadily less likely. It also means that the gap between Turkey and the more prosperous members of the European Union is steadily narrowing-well ahead of any realistic date for accession. Already, Turkey is more prosperous than a number of the newer member states.
	The new foreign policies pursued by the trio of Prime Minister Erdogan, President Gul and their hyperactive and imaginative Foreign Minister Ahmet Davutoglu also have many good features. It is surely in the general interest that Turkey should pursue the so far rather tentative rapprochement with Armenia and should play an active role in stabilising the Caucasus and searching for solutions to its territorial disputes. Similarly, a Turkey which has developed a good relationship with Syria has potential to lend a hand in the Middle East peace process and the better relations between Turkey and the Iraqi Kurds, taken together with continued efforts at reconciliation with its own ethnic Kurdish population, serves wider western interests in the region.
	Is everything in the garden perfect? Not quite, I would suggest; there are some risks ahead. Turkey has yet to demonstrate that it can undergo a transfer of power from one party to another, or to a coalition of parties, without putting at risk the economic and political gains of the past 10 years. That could be put to the test following this year's general election or perhaps later, but it certainly cannot be postponed for ever. Turkey surely needs to put its rising self-confidence to good use by tolerating press criticism and religious minorities in a much better way than it has done up to now. And an electoral law that excludes from its parliament any party that does not get 10 per cent of the vote is surely a European oddity.
	In the foreign policy field, too, there are risks. A Turkey that sustains a dialogue with Iran is highly desirable, but a Turkey that appears to acquiesce in Iran's nuclear ambitions, as seemed to be the case at the time of the Security Council vote on sanctions last year, would surely be putting at risk its own interests as well as those of the wider world. Mr Davutoglu's precept of "zero problems with the neighbours" is a fine policy slogan, but Cyprus is a neighbour and so too is Greece. The present impasse in the United Nations-led negotiations for a settlement on the Cyprus problem, although far from being solely the responsibility of Turkey and the Turkish Cypriots, will remain a pebble in their shoe for as long as it is not definitely removed.
	What conclusions should Britain be drawing from these positive developments, and can it contribute in any way to reducing the risks? First, the development of a strong, confident bilateral relationship with Turkey such as the coalition Government have already embarked upon must make sense. Secondly, I believe that we are right to maintain unwavering support for Turkey's EU membership bid. The auguries may not look particularly promising in the short term, but a country like our own, which took "We will not take no for an answer" as its own motto when vetoed by General de Gaulle for the second time in 1967, is well placed to argue that if Turkey does likewise, it too will succeed over time. We should be pushing strenuously for the freeing up of some of the blocked chapters in the negotiations so that they can continue to move forward, while still leaving those opposed to Turkish entry the possibility of blocking it at a later stage. I doubt myself whether an impasse in the negotiations later this year, when the chapters available run out, is in anyone's interest-least of all, I suggest, in the interest of Cyprus, since decisive progress in Turkey's accession bid is surely the key that will unlock the door to a solution of the Cyprus problem. Thirdly, we should be doing all that we can to help move those Cyprus negotiations forward. The United Nations faces the usual Sisyphean task and needs all the help it can get; unaided, it will not succeed.
	On this analysis, Turkey's emergence as a rising power has plenty of positive factors for us as well as for Turkey. That country's success in avoiding the inevitable traps that we face is very much in this country's interest and something that we should be doing our best to help it to achieve.

Baroness Hooper: My Lords, as has become evident in the course of this debate, Turkey is a special country. It is a large and significant country and a very beautiful one, as the many tourists who travel there will agree. Turkey's contribution to the field of cultural heritage has been considerable. It has been the gateway to Europe since early Christendom and before, and has been a bridge between east and west.
	I shall refer particularly to Turkey's role in the Council of Europe. I was a member of the UK delegation for 10 years and saw the active and responsible role that the Turkish delegation played in the Parliamentary Assembly. Indeed, at this moment a Turkish Member, Mr Cavasoglu, is the elected president of the Parliamentary Assembly, and the president himself is a former member of the Turkish delegation.
	In the Council of Europe, the Conservative group sits in the European Democratic Group with members of the Justice and Development Party from Turkey, and we work together with all the other nationalities in the group in a most harmonious and constructive way. Mr Cavasoglu, to whom I have referred, now the president of the Parliamentary Assembly, was in fact our chief whip.
	It is often forgotten that Turkey was a founder member of the Council of Europe in 1948, and that membership was welcomed in a war-torn post-war Europe. Nobody in France or anywhere else suggested at that stage that Turkey was not European. The same goes for Turkey's support of and involvement in NATO. Admittedly, Turkey's membership was suspended during the military dictatorship, when the condition of having a pluralistic democracy was not fulfilled. There have also been human rights problems, as there have been in many member countries of the Council of Europe. However, I believe that that is all a thing of the past. Therefore, with regard to European Union membership, the argument that Turkey cannot claim to be a European country is not valid and, in any event, it is a bit late to suggest it.
	The real reasons why Turkey's membership of the European Union is being delayed and blocked in some quarters are much more to do with its size and the fact that it would be the largest country in the European Union; and the fears that, as a result of the freedom of movement of labour provisions, our labour markets would be swamped. That is clearly something that needs to be worked out and suitable transitional arrangements made. However, given the OECD predictions that Turkey's economy is growing at an above average rate and is likely to be the second largest economy in Europe by 2050, it seems that the boot is rather on the other foot. The likelihood is that it is our labour forces that will head for Turkey, not the other way around.
	I welcome the fact that the coalition Government continue a policy of support for Turkey's membership of the European Union. I congratulate my noble friend Lady Hussein-Ece for introducing this important debate and I look forward to hearing from my noble friend the Minister when he replies in what I feel sure will be a very positive way.

Lord Sharkey: My Lords, it is a great privilege and a great honour to join your Lordships' House. It has also been a great pleasure because of the immense kindness shown to me by my supporters, the noble Baronesses, Lady Scott and Lady Bonham-Carter, and noble Lords from all parts of this House, and the kindness and apparently endless patience of all its officials.
	My working life to date has been chiefly concerned with the communications industry and, in the past six years or so as a trustee of the Hansard Society, with the study of our parliamentary and democratic institutions. I hope to speak on these topics in your Lordships' House in the future. The Motion before your Lordships today presents me with an opportunity to speak on perhaps my longest-standing and most enduring interest outside the UK: Turkey. I am very grateful to my noble friend Lady Hussein-Ece for introducing the subject today and for speaking so well and persuasively on such an important matter.
	My own involvement with Turkey goes back 45 years to my first visit. I have managed to revisit the country almost every year since, once or twice for extended periods. Twenty years ago I was charged, with my noble friend Lord Dobbs, by the then Turkish Government with helping to expedite progress towards membership of the EU. This speech is not a way of making good that long-ago obligation. I understand the convention that requires maiden speeches to be uncontroversial, and how easily remarks about the Turkish position vis-à-vis the EU or the Middle East may be characterised as controversial. I will accordingly confine my remarks largely to my own experience of and reflections on Turkey and the Turks, and simply note some of the more striking facts.
	In my 45 years of contact with Turkey I have, as you might expect, seen profound change. I have also seen some things remain constant throughout this period. I remember vividly how struck I was by the graceful and unforced hospitality of a traditional Islamic culture. I am struck now that this tradition survives such major political, social and economic changes. I was also struck by the strong sense of a European cultural heritage, not just in the great Roman and Byzantine monuments in Istanbul, but in the astounding remains of Ephesus and other Greek towns, and in the huge underground early Christian cities of Cappadocia.
	I am conscious, too, in conversations with Turkish friends and business colleagues, of the central role that Europe and the idea of Europe has played in shaping post-Ottoman Turkish thinking and the post-Ottoman Turkish state. No speech about Turkey would be complete without respectful reference to the architect of this modern Turkish state, Kemal Ataturk, his admiration and respect for European institutions, his vision of Turkey in Europe and his creation of a secular Turkish state modelled on European lines.
	As I have revisited Turkey over the years, often on business, I have been deeply impressed by the changes I have seen. What was, when I first encountered it, a broadly agrarian economy, has in the intervening years transformed itself into a modern and powerful industrial nation. When I first visited Istanbul, it was a city which contained sellers of medicinal leeches, itinerant letter writers and the occasional dancing bear-all quite romantic if your fancy lies that way. Now when I visit the city, I see home-grown multinational companies, vibrant stock exchanges, well regulated and well funded banks and a proud and strong cultural tradition, continuous with the past, in which the influence of the European and of the Ottoman is clearly and proudly visible.
	Other speakers today will be better qualified than I am to talk in detail about the economic importance of Turkey to the EU and to the region, but I would like simply to point out that already by 2007 the EU accounted for 56 per cent of Turkey's exports and for 41 per cent of its imports. Turkey ranks seventh in the EU's top import markets and fifth in its top export markets. But perhaps one of the most striking ways of illustrating Turkey's strategic and economic importance in the EU and in the region is to look at modern Istanbul, European Capital of Culture for 2010. A research paper published in December by the Brookings Institution, the LSE and Deutsche Bank looked at the economic fortunes of the world's top 150 global metropolitan economies. The study shows Istanbul to have beaten Beijing and Shanghai to claim the title of "most dynamic metro city".
	The second part of my noble friend's Motion calls attention to the strategic role of Turkey in Europe and in the region. This strategic role has, I think, been pretty evident from economic, political and military perspectives for most of the past 2,000 years. It was certainly recognised by the Greeks in antiquity and by their Roman successors. Constantine the Great made it the capital of the Eastern Empire and Anatolia was the breadbasket of both the Byzantines and the Ottomans. It is recognised by modern Europeans in modem times too. Herman Van Rompuy said, just before last Christmas:
	"The EU should develop a close partnership with Ankara, without waiting for the outcome of accession negotiations".
	In our own times Istanbul and Anatolia are the fulcrum on which the interests of the established West and the emerging Near East are finely balanced. One has only to think about Turkey's geographical position, its membership of NATO, its neighbours in every direction, its function as a conduit for the oil, gas and goods from the East, its economic strength and resilience, the youth of its population and its energy and cultural creativity to realise how strategically critical Turkey is to the EU and to the region. We must reflect also on the merits of having a Muslim nation, secular and democratic in government, as a good, willing and valued neighbour. All this, or most of it anyway, became true and important in 1453. It remains true and important in 2011. I truly believe that Turkey's economic and strategic role is important to us and that it deserves the most careful consideration.

Lord Clement-Jones: My Lords, it is a huge pleasure for me to congratulate my noble friend Lord Sharkey on his superb maiden speech. I apologise to him for my slightly late entry as a result of not being aware that the noble Lord, Lord Ahmed, was not speaking. My noble friend Lord Sharkey has had a long and distinguished career, principally in advertising, and as the House has seen he is a skilled communicator and advocate, which gives hope to all maths graduates. The Liberal Democrats particularly know my noble friend for his competent and imperturbable chairing of our general election team at the previous election. However, if you take a look at his CV, it is-how shall I put it?-his cross-party experience which could be of the greatest benefit to this House. I welcome him to this House on our behalf.
	I also congratulate my noble friend Lady Hussein-Ece who, as a relatively new Member, has really hit the ground running with this debate and her especially superb and forceful speech. I agreed with every word she had to say which, your Lordships will be grateful to hear, will probably result in my own remarks being cut much shorter.
	I must first declare an interest. I have visited Turkey for some 30 years, have a second home in Turkey, am a partner in a law firm with an important office in Turkey and am the vice-chairman of the All-Party Parliamentary Group for Turkey. I am glad to say that for the past few years, under both this and the previous Government, the UK has had excellent political relations with Turkey. As we know, in October 2007 the strategic partnership was announced during the Turkish Prime Minister's visit to the UK when Gordon Brown was Prime Minister. This was followed up last July by David Cameron who agreed a new strategic partnership with the Turkish Prime Minister during his recent visit there.
	There is no doubt that the AK Government have done an extremely good job with economic management. The switch to the new Turkish lira occurred not that long ago, although I suspect that many have now forgotten it. Last year the Turkish economy is estimated to have grown by nearly 8 per cent, by 11 per cent in the first half alone, and is forecast to be the second fastest growing economy in the world by 2017. It is now the world's 16th largest economy. As we have heard, the UK is Turkey's second largest export market with more than 400 British companies investing in Turkey, many of them major companies such as BP, Shell, Vodafone, Unilever, HSBC and Tesco.
	I want to talk principally about Turkey's relationship with the EU, central Asia and the Middle East. In a speech at the Turkish Parliament in Ankara, Mr Cameron said that the European Union without Turkey at its heart was,
	"not stronger but weaker ... not more secure but less ... not richer but poorer".
	I completely agree with those sentiments. In Britain many of us feel that Turkey has had to wait too long for EU membership in comparison with other new member states. As we have heard from several noble Lords, since 2005 only 13 out of 35 negotiating chapters relating to accession talks have been opened for discussion and only one has been provisionally closed. However, after the eastern and central European accessions it is vital that the European Union does not turn inward. Rejection of Turkish membership would indicate that the EU saw the membership of a large Muslim nation, however secular in its constitution, as some kind of threat to its identity. This would be a dangerous message to send to our Muslim citizens. There is a worry that if accession is blocked, as my noble friend said, the EU will be perceived as a purely Christian club.
	The EU must be an outward-looking institution. However, as we have heard, Turkish accession is not currently supported by France or Germany, so what are the advantages of Turkish membership of the EU? First, during the recession it has had a strongly growing economy at higher rates than all EU countries. It has a young, well educated population, unlike other parts of Europe which have an ageing population. We can all quote the figures about the percentage of the population being under 34. Such a young growing population could significantly stimulate EU growth to the benefit of us all. There are more than 3,000 young Turkish students in the UK, studying at and contributing to our universities. It was very interesting to hear about the experience of Warwick University and the partnerships that it has.
	Then there is the question of energy security, as we have heard. Turkey is a natural hub between several vital energy suppliers and energy consumers and can become a crucially important hub for both oil and gas supply. If we had the Nabucco pipeline, which would involve building a gas pipeline from the Caspian through Turkey, Bulgaria, Romania, Hungary and Austria, it would become the first pipeline directly to link western Europe with non-Russian gas. The EU would gain a reliable alternative supply route from the Caspian and, as I discovered last week in Iraqi Kurdistan, from there too.
	Turkey can also play an important role for the EU in bridging the gap between Europe and the wider Muslim world, as we have heard from a number of noble Lords, especially under the proactive Foreign Minister Davutoglu. With borders with Syria and Iran, Turkey is a gateway to the Middle East and of huge strategic importance to EU security. A key consideration is the harmful effect that a perceived EU rejection of Turkey would have on the EU's foreign policy and its relationships and credibility with the Islamic world in creating an obvious but very real and unsettling view among EU Muslim communities and citizens of the EU.
	I am pleased, however, that relations with the Kurdistan Regional Government in Iraq have become so good and there is great recognition that the KRG and the Turkish system have much in common in terms of democracy, women's rights and the rule of law. There is clearly an important and substantial amount of business investment in Iraqi Kurdistan, which is a force for friendship and stability.
	However, certain issues need to be tackled. I think of the infamous Article 301, which has been amended, whereby it is obligatory to obtain the approval of the Minister of Justice to file a case, but Turkey still needs to improve press freedoms and human rights. When writers such as Orhan Pamuk are charged for insulting the nation, Turkey loses friends. These issues need to be dealt with in order to disarm critics. It is all about willingness to admit problems and institute reform where necessary. However, we must at the same time hold out a genuine prospect of EU membership, not just a cynical exercise.

Lord Sheikh: My Lords, I congratulate the noble Baroness, Lady Hussein-Ece, on securing this debate and for her excellent speech.
	I have always been fascinated by Turkish history and culture. I recently spoke and presented an award at an event to celebrate the achievements of the Turkish community in Britain. Last year, I visited Turkey and the Turkish Republic of Northern Cyprus, where I met government Ministers and leaders in commerce. I know the Turkish ambassador to the United Kingdom and I found him to be an intelligent and articulate person. I also feel that the Turkish diaspora in the United Kingdom and the Turks in Turkey and Northern Cyprus are warm and friendly people.
	The Turkish economy is the fastest growing in Europe and provides a wealth of opportunities for increased trade. As a businessman, I appreciate this. A report by PricewaterhouseCoopers suggests that the UK will, by 2050, be overtaken by emerging economies in the international economic league table. The report goes on to estimate that the emerging group of seven countries, which includes the BRIC countries plus Mexico, Indonesia and Turkey, will by 2017 have a combined economy larger than that of the G7 nations.
	The research also reveals that Turkey's growth will surpass that of Russia by 2050. Turkey's progress is not limited to its newly found economic prowess. The Turkish Government have embarked on a major internal reform programme, including measures in respect of freedom of expression and journalistic freedom. However, more needs to be done in this regard. I welcome the Turkish Government's decision to create a parliamentary committee for women's rights. I have spoken about this important issue on a number of occasions in your Lordships' House, and I therefore commend this development.
	The Turkish Government has also gone to great lengths to improve and strengthen relationships with a number of countries, including Syria, Armenia, the Republic of Macedonia and Russia. Turkey's cordial relations with Iran should not be underestimated in efforts to persuade Tehran to suspend its nuclear enrichment programme.
	Turkey is a member of the North Atlantic Treaty Organisation, and Turkish soldiers are serving in Afghanistan. It is inevitable that the Turkish state should take its position as one of the world's leaders. Geographically, it connects the Middle East, the Black Sea, the Caucasus and the Balkans. Ceyhan, in southern Turkey, is a vital network for transporting oil and gas to Europe and the Middle East. The Baku-Tbilisi-Ceyhan crude oil pipeline is one of the largest investment projects in central Asia. The Kirkuk-Ceyhan pipeline that links Turkey with Iraq is also a key source of oil transit. We in the United Kingdom and Europe need to have security of energy supply, and these arrangements are indeed vital.
	I am pleased that for a considerable period the Government's policy has been supportive of and sympathetic to Turkey's aspirations to join the European Union. I, too, am supportive of these goals. We should not forget that talks on this issue began as early as 1987, and more than 23 years later progress remains frustratingly slow. Turkish accession to the European Union would deliver real economic, cultural and security benefits to both Turkey and the wider European Union. I would welcome any comments from the Minister on plans to convey this message to our leading partners in the European Union. We should be aware of the internal dynamics. In 2004, nearly three-quarters of Turkey's 73 million people were supporters of the bid to join the European Union. Today, that figure has fallen to around less than half. Turkey cannot be expected to be rebuffed constantly or to wrestle continuously with seemingly insurmountable obstacles.
	It is important not to avoid the issue of Cyprus. Turkish Cypriots feel isolated and Turkey has a role to play in encouraging a settlement there. As I mentioned earlier, I have visited the Turkish Republic of Northern Cyprus and feel that the problems need to be resolved. It was a missed opportunity that this was not done before Cyprus was admitted to the European Union. However, I understand that the discussions between the leaders involved in this long and unhappy conflict are making reasonable progress.
	Turkey has been a good friend to the United Kingdom, and has been supportive of our multilateral efforts. She has stood by us and offered unequivocal support in our international engagements. Turkey is uniquely placed, and stands as the fulcrum between East and West, and between Christian Europe and the Islamic Middle East. She is a democratic nation, willing and able to stand by her allies. I acknowledge that the Government have adopted a positive, credible and coherent approach in their dealings, statements and actions. Plainly, though, we need to say more about this to our colleagues and partners in Europe, including Germany and France.

Lord Anderson of Swansea: My Lords, in contributing to the welcome debate of the noble Baroness, I shall focus mainly on relations with the European Union. However, as a preliminary point, I should stress our interdependence, which many colleagues have mentioned and which is evidenced today by the signing of the declaration on the Nabucco project by the Presidents of the European Union and Azerbaijan.
	It goes without saying that Turkey has a dynamic economy, and I will not rehearse the numbers mentioned by earlier contributors to the debate. Turkey is an old nation with a young people, and its foreign policy is based on that new economic dynamism. There is an assertiveness, which is mostly but not always welcome, a new independence from the old role as the spearhead of NATO, and a return to a more active regional role. A mere glance at the map will show the importance of Turkey playing that role, and not just in its region. One has seen this in its mediating role in the Balkans and the rather surprising alliance with Serbia. One sees it in its relationship with Russia and the improved commercial relationships with the Turkic-speaking countries to the east. Perhaps I may say in passing that Turkey's relationship with that region is much more welcome than a relationship between the Iran of the mullahs and that region. Turkey's role in the Middle East is also obvious.
	On EU entry, a decade ago it was easy to ask, "Where else could Turkey go?". Now, with this new self-confidence, the answer is more likely to be, "Yes, the EU remains our preferred option, but we have shown that we can stand alone in our region, if necessary". However, this assertiveness is often accompanied by a strident populist anti-Americanism. Anti-western feelings are demonstrated by the gloating over the discomfiting of the US at the United Nations in the vote on sanctions against Iran. In a recent visit to Turkey, under the auspices of the Inter-Parliamentary Union, I was surprised at the number of senior politicians to whom I spoke who were very ready to give Iran the benefit of every doubt on the nuclear issue.
	Greece used to be known as the "asterisk country" in EU foreign policy. If Turkey were to join the EU, it is likely that it would speedily replace Greece as the asterisk country that differentiated itself from the policies of the other EU countries. In respect of Israel, the position has worsened since the AKP came to power. This has recently been highlighted by the flotilla incident. Let us hope that when the UN Security Council report emerges in mid-February, it will calm matters. Certainly the referendum in September is very welcome.
	Where does Turkey stand now in relation to EU entry? Its ambition is to enter by 2023, the anniversary of the foundation of the republic. By 2023, the EU might be very different. By that time, Turkey, too, might be very different. There is thus an argument for looking at the long term. A number of countries in the Balkans have overtaken Turkey in their EU ambitions. Some argue that Islamophobia has played a part. I believe the part has been minor. The recent EU Commission report on enlargement, for example, very warmly endorsed Albania, another Muslim country.
	The problem with Turkey is its size, various cultural matters and its dynamic demography. Even without the major problem of Cyprus, the EU is clearly deeply divided. We perhaps forget too readily that France would have to have a referendum, which might make Turkish accession very unlikely. Therefore, one must look at other options. If immigration is to be such a sizeable obstacle, why not look at going ahead without freedom of movement? We need to show the importance that we attach to aiding Turkey in its fight against terrorism. We need to seek to join Turkey in EU foreign policy discussions. Why should Turkey not be linked with the CFSP? There is clearly a divergence between the elites in Europe and the people, and it is clear that demography and immigration are very much behind that.
	My final remark is about how we see our relations as Europeans. The safe course for Europe would be to have a zone of comfort and to have a comparative and rather genteel decline, with special relations with its periphery: Ukraine, Russia and Turkey. The bolder and perhaps more turbulent course is to recognise that the Turkey of today is not ready for entry, but we need it-if it satisfies the Copenhagen criteria, perhaps with derogations-to give a certain dynamism to Europe. Currently there is stagnation, indecision and a degree of hypocrisy on the issue in the European Union, but the crisis looms this year or next. The choice is there, the drift cannot continue and it is for us as Europeans to choose the nature of our future.

Baroness Nicholson of Winterbourne: I welcome this important and timely debate and I thank the noble Baroness for providing this opportunity, which gives all of us the chance to praise Turkey's already powerful but still strengthening relationship with the United Kingdom. I repeat how pleased I and other noble Lords are that the new coalition Government have taken extra initiatives in strengthening this relationship, with a new association partnership between Turkey and the UK. Perhaps that is reflected by the great strength of our embassy in Ankara, headed by our ambassador David Reddaway, who has a powerful team that includes UKTI and an outstanding team from the British Council. Our relationship with Turkey is particularly pivotal to its relationship with the European Union.
	I will also comment positively on the vital and invaluably strong position that Turkey has exercised from its earliest days in NATO. Its strength in NATO is perhaps best exemplified by its recent acceptance of an extremely difficult new NATO responsibility in the region that impacts directly on Turkey's bilateral relationships with the nations in closest geographical proximity to it. This shows the extraordinary importance of Turkey's role in NATO, both for other members of NATO and for other countries in the region.
	I particularly welcome Turkey's rapid growth in recent years. Its net export of agriculture dates back to a starting point of 20 years ago. Today, 90 per cent of its exports are industrial goods, the European Union is Turkey's largest trading partner and Turkey has become the European Union's seventh largest trading partner. Such progress stems from the first partnership and association agreement between Turkey and the European Economic Community in 1970 and, with various additional protocols, stretches up to the extraordinarily powerful customs union of 1996. Progress is certainly reflected in Turkey's growth rate of 11 per cent for the first six months of 2010. The European Union, which has a flagging growth rate, and the world in general, can be in no doubt about Turkey's extraordinarily high value in economic terms both regionally and in the wider European and international sphere.
	Politically, Turkey is in a critical geographical position. Its geopolitical importance was shown last October, when the President of Germany broke new ground in attending a Christian service in south-east Turkey. At the same time, the then caretaker Prime Minister Maliki of Iraq, who has now been reappointed as Prime Minister, also visited the Turkish Government and Parliament.
	Turkey looks both ways and its power in that position was perhaps shown most clearly to me in two contrasting but complementary activities that I witnessed. Through the whole of 2010, Istanbul proudly celebrated its status as European city of culture. I visited the city four times and saw the glorious cultural activities that were going on. At the same time, Turkey's trade and industry intensified efforts in some of the more difficult areas of the region. When in 2009 I visited the first trade fair for a decade in Baghdad, the Turkish pavilion was crammed with stalls and activities. Whereas UK business and industry was, alas, not present at all, the Turkish pavilion shone. I am glad to say that in the past year I managed to correct that in a personal initiative by getting-in my capacity as chairman of the Iraq-Britain Business Council-some representatives of British industry into the new trade fair in Iraq, although other businesses from Britain were not there.
	Turkey looks both ways and is active not just in those ways but all around, because it has secretaryship of the Organisation of Islamic Countries. Having a broadly Muslim population, Turkey also shines out because it has a secular constitution. Therefore, Turkey demonstrates conclusively that Islam-Muslim communities and populations-can embrace democracy, the rule of law and fundamental freedoms. As Turkey moves closer to the European model, this gives the lie to the comments of so many people that Islam cannot accept democracy.
	I have been a supporter of Turkey's entry to the European Union since the early 1980s, but I know that still more steps need to be taken. The European Parliament's report of 21 September talks of the need to eliminate further non-tariff trade barriers, to open up public procurement and to bring in respect for intellectual property, including the fight against counterfeiting, and easier visa procedures, particularly for lorry drivers. Can the UK Government do more in these important economic matters? The easing of those final free-trade barriers may well be the key to reassure the nervous members of the European Union-France, Germany and Hungary, in particular-that, as a full member of the European Union, Turkey would strengthen our hand and would be a positive partner for good.

Lord Kilclooney: My Lords, first, I congratulate the noble Lord, Lord Sharkey, on his maiden speech. He is clearly a welcome asset to our House and we look forward to hearing from him on many further occasions. I also congratulate the noble Baroness, Lady Hussein-Ece, on moving her Motion on the very important subject of Turkey. I have been visiting Turkey regularly since 1972 and declare an interest as an officer in the British-Turkish All-Party Parliamentary Group. We hear so often about the new Asian economies or about the BRIC countries-especially Brazil and China-but nearer to home here in Europe is Turkey, which has been one of the most interesting developing countries over the past five years. It is good that we are concentrating on Turkey today.
	In the new year the Prime Minister of Turkey, Mr Erdogan, held a conference in eastern Turkey that brought together all 180 Turkish ambassadors to discuss diplomatic relations with Greece and Cyprus and the European Union application. Interestingly, in the context of Greek-Turkish relations, his guest was the Prime Minister of Greece. Perhaps we in the United Kingdom could follow that initiative by ensuring that all our ambassadors are brought together now and again, so that they all sing from the same hymn sheet.
	Turkey is a modern Muslim democracy, as has been repeatedly stated this morning, and it is also the second largest European nation and a member of European institutions. The noble Baroness, Lady Hooper, mentioned how she-and I with her-were working with our Turkish colleagues in the Council of Europe. Turkey is also a member of the OECD, NATO and, most important, UEFA, which organises the European soccer contest. Even more important, Turkey is a member of the European song contest. Turkey is very much a European country in many respects. Of course, as has been stressed, it is a bridge between Europe and the Middle East in its key geographical location.
	We will not go into Turkey's economy in detail, but I emphasis yet again the rapid growth in Turkish exports, which were up by 11 per cent last year to $113 billion. More interesting, the GDP per capita in Turkey is now $8,590, which is already greater than that of some EU member states, such as Bulgaria and Romania. Equally important, the Turkish economy is now larger than that of Belgium, Poland and Portugal. Although an applicant country, Turkey is already ahead of quite a few member states of the European Union but its application has dragged on endlessly since 2005. Those who take an interest in Turkey will recall that the application was accepted only 60 seconds before midnight at that important meeting when it was decided that the EU could accept Muslim Turkey only as long as it also accepted Roman Catholic Croatia. Both were accepted at the same time, but Croatia's application has moved ahead quickly while Turkey's is still being delayed.
	Belgium, which had the EU presidency in the past six months, failed to advance the Turkish application, but Belgium had other problems, having failed to form a Government after its own general election. Some said that the EU was being presided over by a failed state, which sadly seems to be the case. The UK, under both the Labour Government and the coalition Government, shares support for Turkey's EU application, but it is strongly opposed not only by Germany and France but by Austria. That is causing Turkish realignment away from its traditional allies, which should concern European nations.
	Turkey is becoming an influential nation in the Middle East and in the Caucasus, and it is developing closer relationships in the Middle East. Turkey is no longer neutral but is now a supporter of Arab and Muslim causes against Israel. As the noble Lord, Lord Chidgey, pointed out, Turkey no longer requires visas for people from Syria, Lebanon and Jordan. Now Turkey has a new treaty with Russia, which is abolishing visas as well. We should compare that with the attitude of European Union countries towards the requirement of visas from Turkish people entering the European Union.
	Of course, Turkey has problems with Greece. The Aegean Sea issue still needs to be resolved to the satisfaction of both. Indeed, the decision by Greece only a week ago to build a 12.5 kilometre barrier fence or wall-I am not sure which-between Greece and Turkey does not seem the most friendly of decisions. Cyprus is the main issue. We all know why it is a problem. A coup d'état, which was inspired by Greece in 1974, removed the democratically elected President Makarios from office. Since then, there have been two entities within the island of Cyprus. Turkey supports the United Nations-sponsored talks for a political settlement in Cyprus, but after 37 years there still seems little prospect of agreement. Increasingly, people are beginning to consider a permanent division of the island, and that reality should not be avoided. Latin American nations, including Brazil and Argentina, in recent weeks now recognise Palestine. If Muslim nations began something similar and recognised northern Cyprus, an international solution would become a reality.
	I welcome the debate, which underlines the importance of Turkey within Europe and as a friend of the United Kingdom. I am delighted that both sides of the House support Turkey in its application to join the EU.

Lord Selsdon: My Lords, when I first joined your Lordships' House in 1963, I was told that I ought to speak, but I pointed out to my superiors that I had no knowledge or experience. They said, "Don't worry, my dear chap, go into the Library and you can borrow other people's experience". I remind noble Lords that, being on the Information Committee, I am proud to say that the Library is now taking initiatives and many who have spoken today may well have received a report from the Library. I commend it to you-it is also on the internet-although it makes a few mistakes, in that it says an awful lot about what has been said by the Prime Minister rather than by people who know better .
	For the first time, I shall speak from my own experience. I am grateful to my noble friend Lady Hussein-Ece because I have certain knowledge and experience in some of those areas that I want to share with your Lordships. I may be able to draw no conclusions as everything that has been said that could promote Turkey has already been said. We are obviously great Turkophiles.
	At a fairly early age I joined the Navy and we then had a problem in the Middle East. Before I knew it, I had become an officer-too soon. I was unqualified and was shipped out as a bit of baggage for the Suez business. I was made a junior officer on Cyprus patrols in a coastal minesweeper as part-navigating officer, having never been to sea. For two happy years, I was based in Famagusta and sailed around the north of Cyprus, particularly to Lotte's bar in Kyrenia, which may possibly still be there. As the noble Baroness will know from her origins in Turkish Cyprus, such places are great. I found, too, that there was a bit of trouble. As a young man who suddenly has to lead a small team to try to put down a riot in Famagusta, you start to face seeing death for the first time. At that time, because I liked the sea and sailing, we used to go on trips to show the flag. We went into Beirut with the fleet for the first time after Suez. Being the most junior person, speaking French, I had to organise cheap deals in the nightclubs. I never had to do anything particularly important.
	Occasionally, we would go on another trip. One day, they told us that we were going to Turkey. I have to say that I was not quite sure where Turkey was. I thought of Cyprus as just being full of Greek terrorists; I did not fully understand the involvement. I was asked to plot the course to Turkey and, on the way, to say where we were going, but I dropped the sextant. Unfortunately, I found that we were going somewhere into the mainland of Turkey.
	Those trips gave me one great love-a love of the sea. St Paul was my hero, so I set out to see whether I could follow the three voyages of St Paul. I found that St Paul went more often than anywhere else to Turkey, but the Turks are not really sea-going people. They have a coastline of about 7,000 kilometres-the same as India. Greece has a coastline of 12,000 kilometres-the same as the United Kingdom. In order to be a sea people, you have to have the sea, and the Greek have more sea and therefore more ship owners, but the Turks have more land and more people. The Turkish people are, when they are pushed, pretty warlike and really great fighters. Most of their conquests were by land whereas, in many other cases, such as ours, they were by sea. As your Lordships will know, Marmaris was the base for Nelson before he fought the battle of Abukir Bay. As you go back in time, you find an historic relationship.
	I then did something very stupid. I went out, borrowed a lot of money and bought a nice boat. For 14 years I sailed the coast of Turkey and Greece-like the noble Lord, Lord Sharkey, I got to know it well. You even found co-operation with the Greeks. We were trying to save the loggerhead turtle off Caunos, one of the old ports. Who came into the breach but Melina Mercouri. I had always loved her from "Never on Sunday". We found support for ecology. The thought was that the Turks were not very good on ecology but, gradually, the whole of that area opened up. I used to take children of friends-as many as I could-to make them learn to sail, but they also had to learn history. The first question was: where are the seven wonders of the world? One basis for that-which is, to some extent, where I started-was Bodrum, where the tomb of King Maussollos was.
	We then found a sail-maker who was also a great sea journalist, Rod Heikell. Together, we wrote a book-he did all the writing and the research; well, I did some of it -called the Turquoise Coast of Turkey, which is still available. For every little port, he gave the history. Before I sit down, I will give your Lordships just one example: Knidos, which has two harbours, one Greek and one Roman, where the triremes would go out to attack people in the Gulf. Knidos also had two temples, one Greek and one Roman, and was the first place to have a statue of a naked lady-all naked statues before that were of men-which was Aphrodite. People would pay a large amount of money to be able to be placed close to that statue. All those things had great movement for me.
	One day, I was chairman of the Committee for Middle East Trade. The Foreign Office rang me to say, "Although you've got the Arab world, we have now given you Turkey". I said, "Turkey is not part of the Middle East; it is not part of Europe. Turkey is Turkey".

Lord Giddens: My Lords, Turkey is Turkey.
	I join the long queue of noble Lords in congratulating the noble Baroness, Lady Hussein-Ece, on having initiated this debate, and the somewhat shorter queue of noble Lords congratulating the noble Lord, Lord Sharkey, on his truly excellent maiden speech.
	I shall concentrate my comments on the thorny issue of Turkey's potential accession to the EU. As so many other noble Lords have already talked on that topic, I will try to zoom in well below my six minutes. I should declare an interest as a former member of the Ahtisaari commission on the EU and Turkey and pay tribute to the work of my colleagues on the commission, which has deservedly been very influential.
	At first sight, the quest for Turkey to join the EU seems like "Mission Impossible". That is how many people on both sides have come to see it. I am pleased to see from this debate that that view is not shared by Members of your Lordships' House; nor is it shared by me. The problems in the way are well known and have been alluded to by other noble Lords. First, there is the stuttering nature of the accession process, with many chapters of the acquis being frozen. Secondly, there is the hostile attitudes of some of Europe's key leaders, who have been alluded to in the debate. Thirdly, there is the seemingly intractable issue of Cyprus, for which the EU must accept a high percentage of blame, having allowed Cyprus to enter the EU before a constitutional settlement was reached. Fourthly, there is the consequent cooling of public opinion on both sides. A survey in 2008 showed that only 28 per cent of EU citizens were in favour of Turkey joining the EU, down from 44 per cent a couple of years earlier. A poll in Turkey in 2010 showed that only 38 per cent of the population supported entry into the EU, down from 73 per cent in 2004.
	The end of a dream, then? Like other noble Lords, I do not think so. The structural ties that bind the EU and Turkey are very strong. Consider what might happen if the EU and Turkey continued to drift apart. As other noble Lords have said, Europe would be defining itself as a Christian community, not the cosmopolitan body which in fact it is, as millions of Muslims are already part of the Union. Turkey might enter into alliance with authoritarian states, possibly succumbing to rising Islamic radicalism. A prosperous, democratic and secular Turkey is in everyone's interests.
	The vicious circle that exists can be broken, but it is obvious that creative thinking will be needed at this point. I make three quick remarks on that. Cyprus, as other noble Lords have mentioned, remains a prime sticking point, but there are a lot of interesting ideas around. I mention in particular the 11-point plan proposed by the International Crisis Group, which is a promising way forward. Secondly-again, as others have noted-the pace of reform in Turkey needs to be stepped up again following the so-called golden era of transformation in 2000 to 2005, but it is worth recognising that the AKP has made more progress with the Kurdish problem than any previous Government.
	Thirdly, the EU is itself in crisis, as we know, and its future is opaque. However, that situation should encourage experimentation. I agree with those who say that the EU should work with Turkey outside the framework of the accession process and that foreign policy and energy security are two key areas where it is obvious that that could be successful. I do not think that that would compromise the acquis; it would strengthen it. The case of Nabucco has already been mentioned.
	I therefore join other noble Lords and the British Government in strongly endorsing the case for keeping Turkey on track for membership of the European Union.

Baroness Scott of Needham Market: My Lords, I join the congratulations to my noble friend Lady Hussein-Ece on securing this important debate today, on her excellent introduction to it, and on giving us the opportunity to hear important contributions from across the House-in particular, from my noble friend Lord Sharkey, who I thought made an extremely good maiden speech. I know that the whole House will look forward to hearing from him again on this and other topics.
	The Motion refers to the role of Turkey in international affairs. I shall address my remarks to one geographically very small area of Turkish influence, but one that has enormous strategic importance. I refer to Cyprus. The motive behind my contribution is simple. It is born out of a great interest in and huge affection for Cyprus. I lived in Nicosia and in Limassol as a small child when my Air Force father was stationed at the early warning radar station in the Troodos mountains, and I have been a regular visitor ever since, most recently in October, for the wedding of my daughter in Paphos. After that event, I took the opportunity to cross into northern Cyprus-at the invitation of the Government-to have a look and to have a series of meetings and to pay some visits over what was a very busy and interesting three-day period. I used the Ledra Palace crossing-which is a strange experience: a 500-metre walk in bright sunshine through abandoned, very quiet and war-damaged Nicosia suburbs. The whole thing had something of a John Le Carré feel to it. In fact, it is said, perhaps apocryphally, that modern-day Berliners like to try the experience just to remind themselves of how it used to be.
	So what should be done about this long-standing division of Cyprus? It is worth reminding ourselves that Cyprus has been divided since 1963 and that the United Nations has been keeping the green line between Greek and Turkish Cypriots since then. It is not something that happened since 1974 and the arrival of Turkish troops.
	With the ease of crossing, perhaps the outside world wonders whether it is worth bothering to try to find a solution to Cyprus-everybody is getting on, everything is all right. I believe that it would be a big mistake to think that way. First, for the people of Cyprus, all of whom are EU citizens, there is a high price to pay for the current lack of an agreed settlement: both sides live with large numbers of troops; economic development, especially in tourism, is damaged by a division which looks inexplicable to modern visitors from outside; and property markets are damaged by uncertainty over title. Perhaps most important of all, infrastructure decisions on this small island, which ought sensibly to be made on a whole-island basis, are being made separately. The most obvious example is water, where the Greek Cypriot solution to the chronic water shortage is to build desalination plants, while the north is planning a water pipeline direct from Turkey.
	It seems to me that the role of the United Kingdom in helping to resolve the Cyprus question is absolutely key, because of the historic links of Empire and Commonwealth, because of our status as one of the guarantor powers, because of the strategic importance of the sovereign bases in Cyprus and because of our EU membership-and because we, above all, are the promoters of Turkish accession to the EU. That gives us a moral obligation, as well as a policy obligation, to try to move the impasse forward. We have to be sufficiently realistic to admit that there is now a stalemate in Cyprus.
	On the Greek Cypriot side, there is undoubtedly an emotional desire to see reunification of the island. But the evidence is that it is very doubtful whether that sentiment is matched by any kind of commitment to reach a settlement which offers Turkish Cypriots the protection that they need; and the astounding rejection by Greek Cypriots of the Annan plan was hardly going to engender confidence on the Turkish side, which had voted for it. The acceptance of the Republic of Cyprus into the EU was a mistake and has left a total absence of leverage on the Greek Cypriot side to make any concessions at all.
	In contrast, in northern Cyprus the most important factor is not unification but the need for security, representative governance and autonomy. There is a widespread and understandable feeling that Turkish Cypriots have been let down by the international community ever since unrest escalated in Cyprus during the 1960s. The policy of economic isolation for northern Cyprus is simultaneously creating an economic disparity on the island that makes unification less likely, which makes any kind of resolution less likely and is, indeed, driving Turkish Cypriots into a growing economic dependence, as well as a cultural and social dependence, on Turkey. It is a fact that fewer Turkish Cypriots speak Greek now than was the case in 1974 and that can only make life more difficult.
	Yet, having spent a little time in northern Cyprus, it is clear to me that this policy of isolation, while hindering northern Cyprus and stopping it reaching its full potential, is actually not damaging it enough to make the sort of difference that perhaps its opponents might want. It looks to me as though northern Cyprus is thriving despite all of those problems and is not about to cave in any time soon to the pressure of isolationist economic policies.
	It seems to me that it is high time for a rethink. First, all sorts of international organisations, particularly sporting organisations, need to rethink their current policy of bans. These things really do matter to countries. We also should accept the reality that thousands of people fly into Ercan airport but are inconvenienced by the extra time required for a touchdown in Turkey and the extra costs of flights. Finally and most importantly, the EU regulation which would allow direct trade between the EU and northern Cyprus must be implemented. This was promised to Turkish Cypriots and has been blocked since 2004. The Lisbon treaty now gives an opportunity to bring that forward. If this were to be passed, not only would the economic situation in northern Cyprus improve but Turkey would then open up ports and airports to Greek Cypriots, which would help their economy too. I hope the Minister can assure the House that normalising relationships on Cyprus, which is the key to unlocking the accession of Turkey to the European Union, is a high priority for the Government.

Lord Browne of Ladyton: My Lords, I am pleased to follow the noble Baroness, Lady Scott of Needham Market, who brought significant personal experience of the island of Cyprus to enrich this debate. I have experience of the island of Cyprus only as the Secretary of State for Defence, but I know from my observations of the tragedy of that island the need for us to address the impasse there if for no other reason than that it ties down very valuable international military resources on the peace line that the international community could otherwise use.
	I, too, commend the noble Lord, Lord Sharkey, for an assured and informed maiden speech. If he had not told us that he had spent a lifetime in communications, we might have worked that out for ourselves from the way in which he communicated with us. I look forward to his contributions in this House in other areas where I know he has genuine expertise and depth of knowledge.
	I congratulate the noble Baroness, Lady Hussein-Ece, on securing this debate. I thought that her introduction was comprehensive-in fact, it was so comprehensive, as the noble Lord, Lord Chidgey, said, that the rest of us are bit-part players merely reinforcing what she said. As I rise as the tail-end gunner on the Back Benches, I am in the happy position of knowing that everything has been said, although not yet everybody has said it, so I can cut to the chase.
	I intend to make three points. One is a point of observation and information and two are points of inquiry, which I shall come to in a moment. Before turning to that, I should draw the attention of the House to my entry in the Register of Lords' Interests, particularly an entry relating to a visit to Ankara in October 2010 when I took part in a roundtable discussion on NATO's defence posture and Turkish security. That roundtable seminar and discussion was supported by the Arms Control Association, the British American Security Information Council, the Institute for Peace Research and Security Policy in Hamburg and, very importantly, an organisation known as USAK, the International Strategic Research Organization in Ankara. At this point, I should say that before I went there I was assisted greatly in preparing for that meeting by the embassy and the ambassador from Turkey to the United Kingdom, who facilitated my engagement with some genuine experts on these issues, for which I am very grateful. I promised to report back to the ambassador and if he is able to hear me here today-I know that he is here-I promise him that I will report back to him in detail. I intend to follow up that seminar with a further seminar on this issue in the not-too-distant future. I shall come back to that in a moment.
	The first point that I wish to make arises from the potential in our relations, strategic or otherwise, with Turkey, with its changed and improved position in the world. It is a country of considerably greater assurance and of considerably greater importance in the geopolitical environment that it occupies. I know from my time as Secretary of State for Defence how important that has been to us as a country, not just in relation to Iraq and to our engagement in the Middle East, but specifically in relation to this issue: we have to thank the Turkish Government and their assured position in that part of the world for helping to release the 15 sailors who were taken by the Iranians in the northern Arabian Gulf when they were doing their job there protecting shipping. The Turkish Government quietly and assuredly made a significant contribution to securing their release and, as Secretary of State for Defence at that time-a very difficult time for me-I am very grateful to them. I know that our military are grateful to them, as the country should be. The point that I wish to make is that the potential of Turkey as a strategic partner for the United Kingdom has already been to our benefit and we should continue to exploit that relationship. I am glad to see that our Prime Minister approaches his relations with Turkey in a strategic way.
	My second point arises directly from the reason why I was in Turkey in October last year. My visit was to discuss security issues and nuclear issues in particular. I found a country that has security concerns on a number of issues, including the behaviour of the PKK. It also feels, I think rightly, that it sometimes receives less than full support from fellow NATO allies in a difficult region. None the less, it is a country that is looking to take progressive positions on a number of issues that matter not only to it, but to our country, too.
	Turkey does not want Iran to go nuclear and is seeking to play a constructive role in the international effort to prevent this. We should engage with Turkey on that. I am not necessarily supporting everything that it does, but we should engage with it and recognise the important contribution that it could make. Much more important, Turkey does not want to stand in the way of less NATO reliance on nuclear weapons. That is an ambition that Governments of all types in the United Kingdom share, as does the United States of America. Specifically, Turkey wants to play a role in the removal of sub-strategic nuclear weapons in Europe. The point that I wish to make to the Minister-and I ask him to engage with this-is that we will not succeed in achieving that ambition, which I know that the Government have, unless we translate the strategic relationship with Turkey into a strategic discussion about both the EU and NATO and address the issues that it has, so that we can move from a collective reliance on these weapons as the only manifestation of the cohesion of the NATO alliance. That is a consistent experience that I have had across Europe in talking to other countries with an interest in this area.
	My final point-I am running out of time and have spoken longer than I intended to-relates to EU-NATO relations. These are key to our security, as Afghanistan has proved. Our ambitions in nation building rely on EU resources; we cannot deploy them into semi-secure environments unless we can improve EU-NATO relations. For two organisations that have such consistent membership with each other, the relationships between them are appalling and will be improved, as the alliance itself recognises, only if we address the issues that lie at the heart of that. That will happen only if we engage in proper strategic discussions with Turkey about the issues that cause the barrier in those relationships. I ask the Minister to address these issues in his response if he can, at least in general terms.

Lord Maginnis of Drumglass: My Lords, I welcome this opportunity to speak. I congratulate the noble Lord, Lord Sharkey, on his insightful contribution to the debate. I expected no less, knowing that he traces his roots back to my home county, Tyrone. I also congratulate the noble Baroness, Lady Hussein-Ece, on obtaining this timely debate and hope that, with her more natural authority to speak on these issues, she will be more successful than I have been during the past 28 years in seeking to obtain fairer play, justice and human rights for Turkish Cypriots. That is the issue that I want to address and I declare an interest: I have had a long-term interest in and association with Turkey and northern Cyprus.
	How does one even begin to inject reality into the Cyprus situation where, for example, the Greek Cypriot President Christofias, in his most recent verbal aberration, declared that if he could meet President Gul and Prime Minister Erdogan,
	"the Cyprus issue could be solved over dinner in a fish restaurant on the Bosphorus"?
	Forget the pretension, ignore the insult, because Christofias obviously has little regard for either truth or reality. His mind is so conditioned by his own propaganda that he can easily overlook the Greek Cypriot repudiation of the 1960 Treaty of Guarantee, their rejection of various agreements since then, most recently the 2004 rejection of the Annan plan, and the fact that he, like his predecessors, is willingly held to ransom by the Greek Orthodox Church.
	I wish that I had more time to expand on the negative part played by the Orthodox Church in respect of the rejection of the Annan plan and its relation to the ethnic cleansing that was visited on the Turkish Cypriots between 1963 and 1974. Only a knave or a fool can remain unmoved by the ghettoisation of the minority Turkish Cypriots, by the Akritas plan or by eyewitness accounts of the slaughter that was carried out during the Makarios presidency and by Nikos Sampson and the EOKA-B. I do not have to remind noble Lords that the same democratic deficit, moral deviance and violent hatred still pervade Greek Cypriot attitudes and are still being orchestrated and encouraged today, even on the football field and basketball court.
	What angers me, and shames us all, in respect of the propaganda over much of my 28 parliamentary years, has been the willingness of a limited but verbose group of parliamentarians-mainly, but not exclusively, from another place, through an all-party group, lately known as the Friends of Cyprus, now the Cyprus all-party parliamentary group-to work exclusively to give credence to the Greek Cypriot line while effectively excluding any Turkish Cypriot participation, argument or rights. I remind noble Lords that it was I who was verbally and physically attacked when I dared to enter a publicly advertised meeting sponsored by the Friends of Cyprus in the Jubilee Room, where I spoke merely to remind those promoting the sectarian Greek Cypriot line that the history of Cyprus did not just start in 1974.

Lord Wallace of Saltaire: Order. Interventions in the gap should be a maximum of four minutes.

Lord Maginnis of Drumglass: I apologise and I will wind up. I simply implore the Government to take a more enlightened perspective than the politically myopic Chancellor Merkel, who obviously believes that the way to assist in finding a solution for Cyprus is to visit the Greek Cypriots and lecture Turkey from afar. She did not arrive in Cyprus to support the ongoing talks; rather, she went to stick her oar in before they fail. Berlin's only interest is to keep Cyprus as an anti-Turkish card and I hope that the coalition Government will acknowledge that.

Baroness Symons of Vernham Dean: My Lords, I, too, thank the noble Baroness, Lady Hussein-Ece, for introducing this debate today and for doing it so well and so comprehensively. Moreover, her timing is excellent. Turkey's role in the Middle East, its actual and potential role in Europe, and its importance in Africa is increasingly well recognised and talked about, not only here in this country, but in other European capitals, in the United States of America and, very significantly, throughout the Middle East. Perhaps I may also congratulate the noble Lord, Lord Sharkey, on his excellent maiden speech. I thought it was well-crafted, well-informed and very thoughtful.
	Turkey's economic importance is, of course, self-evident. It is now ranked 17thin the world's economies, and is a significant player around the G20 table, with one of the highest sustained rates of growth in the world between 2002 and 2007. As we know, Turkey was hit very badly by the global financial crisis, with private investment and export earnings falling by a very dramatic one-third in 2009. At the same time, unemployment rose very rapidly, particularly among young people. However, as the OECD said in its report last September, the fundamental resilience of the Turkish economy has allowed it to recover to a growth rate of 6 per cent per annum, although unemployment does remain worryingly high.
	Turkey's vision of its own place in relation to Europe and the Middle East is to secure its role politically and economically. That vision grew throughout the 1990s and has been consolidated in the past 10 years. David Cameron has described Turkey as "Europe's BRIC economy", but, unlike the BRIC countries, Turkey has very few natural resources such as oil and gas, on which those countries and the countries of the Gulf states rely so heavily. So Turkey concentrates on trade and its economic importance is enhanced by its clear determination to trade in as many markets as it can. It is looking north to the Balkans, the Caucasus and the Black Sea area. It is looking to the Middle East and securing trade agreements with many countries there. It has introduced visa waivers, as has been mentioned, for many countries in the Arab League with the objective of expanding its trade. It has secured a hugely important trading relationship with Iraq and has launched an Arabic language television station, as well as increasing the output of Turkish programming into the Arab Middle East.
	That economic activity is further enhanced by Turkey's trade policy to be a link between the Middle East and Africa. Last year alone, Turkey opened 12 new embassies in Africa. Moreover, it secured a trade agreement with the African Union. There are only three such agreements between the African Union and other entities-one with the EU, one with China and now this third one with Turkey.
	In my dealings in the Middle East-I declare an interest as chairman of the Arab-British Chamber of Commerce-I have been struck by how much more frequently my Arab interlocutors talk about Turkey these days. They talk about Turkey as an economic partner and as a strategic political player. The trade partnerships through Turkey with Syria, Iraq and the Gulf states are of huge and growing importance. The noble Lord, Lord Clement-Jones, mentioned the Nabucco line and other trade routes that are opening up in order to avoid some of the greater difficulties that have been experienced by going further north. Moreover, the Middle East trade with Turkey has now reached an all-time high, as the noble Lord, Lord Chidgey, mentioned. It stands at $30 billion per year, as compared with the level only 10 years ago of only $2 billion.
	Against that background, it seems extraordinary that the European Union is still so hesitant in its welcome to Turkey as a full member. Almost all your Lordships have mentioned that point, but I must too from these Benches in no uncertain terms. It is not only extraordinary; it is damaging. It is damaging economically and politically. Now, trade between Turkey and the European Union has started to fall as a result of this sort of reluctance.
	Earlier this week when we discussed the priorities for the Hungarian presidency of the EU, the Minister talked about the importance of the EU's strategic partnership with China, Brazil, Russia and India. But at that time he did not have the opportunity to mention Turkey. When he replies to this debate, will he please update us on this issue of Turkey's EU membership? We know that Mr Cameron supports Turkish membership. Indeed, this country has championed that for many years, right back to the days of the EU summit in Cardiff in 1998 when Tony Blair took on his European colleagues in France and Germany and won the debate. But, as everyone has acknowledged today, that process is now faltering.
	Obviously, unblocking a settlement in Cyprus, as many have mentioned, is crucial. I understand that the Greek Cypriots are now looking at some of the issues in relation to access to Turkish ports and airports as a quid pro quo for relieving their block. That point was made forcefully by the noble Baroness, Lady Scott of Needham Market. But let us be frank, this EU accession blockage is not only about Cyprus, crucial as that is. As the noble Lord, Lord Clement-Jones, said, the rate of progress is painful. It is almost pathetically slow. Can the Minister tell us what discussions the Government have had in particular with France and Germany on this issue?
	The Prime Minister has spoken about protectionism, polarisation and prejudice. They are all good arguments, but what progress has he been able to make? This matters: it does not just matter as an economic issue. It matters in political and strategic terms. In short, Turkey is a vital component in European security. It is a hugely important member of NATO and it is a military power of real significance in the broader Middle East. The European Union's short-term protectionism may well be its long-term weakness.
	Turkey's increased economic ambitions are matched by its increasing political interest in the Arab and Muslim worlds. Prime Minister Erdogan's popularity in the Middle East increased enormously after the Gaza hostilities a year ago, when Ankara was openly critical of Israel. His position was further enhanced in the Middle East by Turkey's challenge to the Gaza blockade over the flotilla incidents. I am very grateful to the noble Lord, Lord Trimble, for reminding us that the report on that issue will be available soon.
	Turkey's championship of the Islamic cause is clearly irritating to the Iranian leadership, which has tried to monopolise that role in the region. But it has also led to a real shift in Turkey's relationships with the rest of the Middle East, which have strengthened markedly. As has been mentioned, it has also put great strains on the relationship with Israel. But let us not forget that Israel received a great deal of help from Turkey in fighting the recent forest fires, which has resulted in a renewal of direct talks with Israel in Switzerland. Can the Minister tell us whether our Government support a clearer role for Turkey in the Middle East peace process? For example, Turkey in the past mediated between Israel and Syria. So could there be a real role for the Turks, in particular for Prime Minister Erdogan who has real street credibility in parts of the Arab world as a negotiator in this process? I believe that that point was alluded to by the noble Lord, Lord Hannay.
	Will the Minister also say something about Turkey's role in relation to that other huge Middle East problem-Iran's nuclear ambitions? Turkey's no vote at the UN sanctions meeting last year clearly came as something of a surprise to the United States. Many commentators believe that Turkey has felt slighted and taken for granted by the US in recent years. Surely, Turkey's role in relation to Iran could be supported and enhanced. The E3+3, the European initiative with France and Germany begun under Jack Straw when he was Foreign Secretary, is supported by the US, Russia and China, and now Turkey, although Turkey is not yet a formal member of that grouping.
	Is not now the time to recognise Turkey's real potential as a mediator and an interlocutor with Iran on this volatile, dangerous and appallingly difficult issue? That point was enhanced by my noble friend Lord Browne in his allusion to the help that we received from Turkey in releasing the British boats a couple of years ago. After all, Turkey is a tried and trusted ally. It is the only Muslim country in NATO. It has 1,300 troops in Afghanistan where it is running a PRT and training sessions for the Afghan Army and the police, and is putting a great deal of aid into the region. To be blunt, its contribution is greater, more engaged and more supportive of NATO policy than many other members of NATO who are somewhat closer to home.
	Although this debate has been about Turkey's relationship with Europe and the Middle East, the other really significant relationship is of course with the United States, which cannot be left out of the equation. The United States-indeed, the international community-needs to recognise that with the increased tensions in the Middle East peace process and over Iran, Turkey can and should be a key ally as a mediator and as a partner in making a sustainable peace in the region.

Lord Howell of Guildford: My Lords, it has been a privilege to listen to this debate. Indeed, so many sensible things have been said-by "sensible things", I do not mean simply repetitions of the clichés of the past, but new and innovative perceptions about this great nation of Turkey-that it is rather hard to know what usefully to add. I obviously join all others in thanking my noble friend Lady Hussein-Ece for securing this debate and for giving us an opportunity to discuss the economic and strategic role of Turkey in Europe and in the Middle East, in relation to issues such as those which the noble Baroness, Lady Symons, has just raised in her perceptive remarks, and globally. That really is valuable.
	I also congratulate most warmly my noble friend Lord Sharkey on his excellent maiden speech, which was very clear and came to the central point, which was echoed in many speeches today, that Turkey is now strategically critical. As my noble friend Lady Nicholson and the noble Lord, Lord Kilclooney, have said, there is a change of perception here. We are now talking about a nation not at the edge of or somewhere between Europe and Asia, but at the centre of a new international landscape, a new pattern of trade and capital movements, and new fortresses of influence and power that have emerged so rapidly in the past few years and to which not every commentator has yet adjusted. In the words of my right honourable friend the Foreign Secretary the other day, Turkey is in a class of its own. If we try to slot it in with other countries or put it into a category, we will fail. This is a central nation in a new global pattern. We need to understand this in order to respect it and make the best of it for our own national interests.
	When the Prime Minister visited Ankara last year, shortly after the coalition Government came to power, he celebrated Turkey's impressive economic performance and valuable role as an international player. Turkey's growing economic power is well known, and noble Lords have referred to it again and again this afternoon. As the noble Baroness, Lady Symons, said, the Prime Minister referred to Turkey as Europe's BRIC. It is somewhat different again. It is set to become the second fastest growing economy in the world by 2017; it has the highest youth population and the fourth largest labour force compared with the current 27 members of the European Union. Its weight is growing in all the great international fora: as a member of the G20; as a long-standing member of NATO and the Organisation for Security and Co-operation in Europe; in the Council of Europe, as my noble friend Baroness Hooper reminded us; and as a recent member of the UN Security Council.
	Turkey is without question an important hub-an energy hub, as many have said-and I prefer "hub" to "bridge". We often use the word "bridge" about Turkey, but I prefer my noble friend Lord Sheikh's description of it as a fulcrum. It is now becoming the centre and more than the crossroads-the hub, indeed-of a whole series of vital international issues and vital interests of this country.
	When the Prime Minister visited Turkey and recognised its growing economic and political power, he committed the UK to strengthening bilateral relations with Turkey by signing a new strategic partnership on behalf of the coalition Government. This, combined with frequent ministerial contact between the two Governments, has forged ever stronger ties between the UK and Turkey. A number of your Lordships are kind enough to recognise that. This is our policy and our aim. It is also reflected in more practical things, such as the fact that no fewer than 2.4 million British tourists visit Turkey every year.
	Every single speech, I think, raised the matter of Turkey's EU accession. Obviously the rising prosperity and the vast networks of relationships and influence that Turkey now embraces in the Middle East and in the Balkans are bound to make it a valuable member of any union, but certainly of our own European Union. That is the simple reason why the British Government remain Turkey's strongest supporter of its ambitions to join the European Union. Of course, it has to meet the conditions of membership of the Union, as it would of any club with the high aims of our European Union-and, of course, Turkey's EU accession would open up further sectors of the Turkish economy to UK exporters, increasing greatly the prosperity of our own country. We have big investments there already, as has been described. We could do a great deal more.
	The accession process, which everyone has recognised is going much too slowly, is also an important stimulus to democratic reform in Turkey, together with improvements in human rights, for which there is room in some quarters. I emphasise that this is a two-way matter. Just as we are talking about the reform of Turkey, we are talking about the European Union making itself fit for purpose in the 21st century, and indeed being, in the words of my noble friend Lord Clement-Jones, an outward-looking, not an inward-looking, community. That is a very important and central point. The EU that Turkey seeks to join-and, I hope, will eventually join-will be of a different pattern to the one we have today. It is evolving, and so it should.
	Let me say a word about the Cyprus issue, which again almost everyone referred to with great expertise, as did the noble Lord, Lord Hannay, who is deeply involved in matters to do with the agonising and seemingly unending problem of Cyprus. Our commitment is to a bi-zonal, bi-communal Cyprus. We are not interested in arguments about partition; I make that absolutely clear. We are fully supportive of UN efforts to achieve a settlement based on the bi-zonal concept, with political equality as defined by the relevant Security Council resolutions.
	The two leaders of the two communities met the UN Secretary-General in New York on 18 November. I am informed that during the meeting the Secretary-General asked the two leaders to focus on core issues and to try to agree a practical plan for overcoming the remaining points of disagreement across all the chapters. We commend the two leaders for the progress they have made so far, although we would like more obviously to commend in particular the work of the UN special adviser, Alexander Downer, whom I have had the privilege of meeting and who is dealing with the challenging role with great energy and commitment. We are seeking to do everything that we can with our EU partners to upgrade the welfare position of the Turkish Cypriot people so that they are prepared, we hope, for the day when we can have the solution that we all want to see. That is where we stand on the Cyprus issue.
	I come now to the broader questions of Turkey's contribution to international security. I will say a particular word about the points that the noble Lord, Lord Browne, made, with his considerable experience in these fields, about the EU-NATO collaboration and how we are working with Turkey on that. We discuss EU-NATO relations regularly at official and ministerial level with Turkey, as well as with NATO allies and EU partners. We have to recognise that a Cyprus settlement may be the necessary way to unblock fully the EU-NATO impasse in the long term, but in the mean time we want to improve practical co-operation as far as possible. We see this as vital for reasons of operational effectiveness-particularly in Afghanistan, where we have the NATO-led ISAF force and the EU police mission-and for reasons of efficiency. We are working with both NATO and the EU to encourage this.
	We were pleased that the recent NATO summit in Lisbon, which included the presence of our Turkish ally, set out the importance of this agenda. We very much recognise the central point made by the noble Lord, Lord Browne. Even more broadly, the Government value the positive role that Turkey plays in building peace and stability in several areas of the neighbouring regions. Turkey plays a vital role in supporting NATO's stabilisation efforts in Afghanistan through its support for the training of the Afghan national army and police, which is a central plank in all our policies. Turkey has also proved to be a crucial partner in efforts to encourage regional co-operation, for example hosting the recent trilateral summit of the presidents of Afghanistan, Pakistan and Turkey.
	As to Turkey's relations with Iraq, it appears-although we must be cautious about this-that Turkey's relations with the Iraqi region of Kurdistan are improving. If business is an indicator, a lot of new business seems to be developing through heavy Turkish investment in the region. Elsewhere, we value Turkey's contribution to the UN peacekeeping force in the Lebanon, where there is a worrying situation that perhaps we do not have time to discuss today but will need to keep an eye on, and Turkey's work to keep Iran engaged in the current E3+3 negotiations on Iran's nuclear programme, about which the noble Baroness asked me.
	These contributions demonstrate Turkey's commitment to international security, and flatly contradict the sort of grand armchair analysis that Turkey must somehow make a choice between East and West and is moving away into an anti-American, anti-western attitude and turning to the rising powers of the East. Turkish people are far too wise to fall for the oversimplification of that choice. As is utterly sensible for it to do, Turkey is seeking its own agenda and role in the new landscape.
	On relations with Israel and the flotilla, which the noble Baroness, Lady Hussein-Ece, and several others rightly raised, we have underlined the need for full, credible, impartial and independent investigation into the MV "Mavi Marmara" incident. We have made it clear that we want to see a process that ensures full accountability and commands the confidence of the international community, including international participation. There is of course the UN panel of inquiry, which was set up to investigate the incident, beyond several other reports that have already come out. The UN inquiry fulfils these criteria, and we will be able to draw much better and sounder conclusions once it issues its report.
	On the hard business side, on which we as a trading nation must always keep a firm eye, Turkey is a vital market for UK exporters. In recognising the amazing rates of growth that Turkey has recently achieved, the Prime Minister the other day set the UK the goal of doubling its trade with Turkey over the next five years. As the noble Lord, Lord Clement-Jones, and others said, companies such as Vodafone, Tesco and International Power are already well established there. UK Trade and Investment is redoubling its efforts to help even more firms to win business in Turkey. In my own department, the Foreign Office, we have been seeking both through our work with other departments and through our posts to promote that aim with the greatest possible vigour. We will continue to do so.
	The Turkey that our Victorian forbears saw as the sick man of Europe and which then emerged out of the ruins of the Ottoman Empire as a new and vital force under Kemal Ataturk has been known well and respected by many of us. However, there is a new Turkey that we must now understand and respect even more, whose international stature and power are growing. It has been described as Europe's only so-called emerging economy, but we must think about questioning even that concept. Some would say, perhaps a little cynically, that if there is any emerging to do, it is just as much in western Europe-indeed, in our society-as it is in the Turkish economy.
	The other day, Robert Zoellick, the extremely able chairman of the World Bank, observed that the very language of talking about the "third world" and "emerging powers" belonged to the previous age, and that we must now recognise that, with globalisation, all kinds of countries that were yesterday seen as being in the "developing country" category are now pace setters: highly dynamic growth economies in the new world setting. Dare I introduce into this debate the thought that our own 54-nation Commonwealth, of which we are a proud member and which used to be seen slightly as a useful talking shop, has now emerged with five, six or seven of the fastest-growing economies in the world and at the cutting edge of high technology? That is far removed from the concept of Britain and the West trying to place their template on the international order and supplying the capital and technology while others supplied the goods and commodities. That world has gone. We must understand that. Your Lordships, perhaps more than many legislatures and assemblies, understand that we are in this new world order.
	Turkey matters intensely on the international stage. As the noble Baroness, Lady Symons, indicated, it is caught up in new patterns of trade flowing north-south as well as east-west: the new silk routes opening up between the GCC countries, the Arab world and the rising eastern powers. Suddenly, we must adjust to the fact that the Middle East, over which Turkey sits with its huge water sources, looks increasingly to the East rather than to the West in its trade patterns and relationships. All these matters are essential for our policy-making, because we must have access to these new partnerships and relationships in order to survive and prosper as a nation ourselves.
	As a key NATO ally and a defence partner, especially in Afghanistan, Turkey is a crucial partner in building international security. Turkey is an immensely valuable partner in counterterrorism and fighting illegal migration, drug trafficking and organised crime. I have not said much about the sensitive area of migration, except possibly to observe that those who fear that the future closer involvement-and, we hope, Turkey's eventual membership of the European Union-would lead to a large shift of population from Turkey westwards may have it the wrong way around. The linking of this highly dynamic economy with our own might lead to flows of population and people seeking the ambience and encouragement of this high-growth economy. Perhaps that is a little fanciful, but these are the possibilities of the future. Furthermore, the size of the Turkish market and its startling rate of economic growth make Turkey without question a significant trading partner for the United Kingdom.
	I have not answered every question, although I have tried. I think I have covered practically all the issues that have been raised in this fascinating debate. I have tried to set out a series of reasons, arguments and assessments as to why this Government attach such importance to our relationship with this great power, which has such a substantial, youthful and dynamic population. We have already taken decisive steps to inject a new dynamic into UK-Turkey relations. I encourage noble Lords-although perhaps I do not need to, because they already recognise the need-to embrace all that Turkey has to offer and to intensify engagement with Turkish counterparts in all fields of interest. This will serve to boost the prosperity and security of our own United Kingdom in the long term, which, after all, is one of our main concerns.

Baroness Hussein-Ece: My Lords, I thank my noble friend the Minister for his comprehensive reply to this Motion. I also thank all noble Lords from across the House for an extremely interesting, positive and wide-ranging debate. There is so much expertise and knowledge in your Lordships' House. I have enjoyed listening to everyone's contribution, particularly that of the noble Baroness, Lady Symons, on the opposition Benches, reaffirming the commitment on her side of the House to the issue of the Motion that we are debating today.
	I have also learnt things. It was interesting to hear my noble friend Lord Trimble talk of ambiguities and challenges. Of course there are challenges; no one denies that. Of course there must be ways, and hope, of resolving some of these difficulties in a positive way.
	I also pay tribute to my noble friend Lord Sharkey for his amazing and insightful maiden speech. I look forward to many other contributions from him. It was timely that he was able to make his maiden speech in this debate.
	I thank all other noble Lords for their contributions and everything that they have brought to this debate. I hope that it will carry on. It has been well informed, and I hope that it will take us forward positively in the coming months and years. Hopefully Turkey will see this as a sign that there is hope in the European Union and that it is not all negative.
	I am particularly grateful to my noble friend Lord Selsdon for his hugely enjoyable and entertaining voyage around Turkey and the Mediterranean. With that, I beg leave to withdraw the Motion.
	Motion withdrawn.

Violence Against Women
	 — 
	Debate

Moved By Baroness Gould of Potternewton
	To call attention to reform of the law, and to the strategy and support services, in relation to violence against women; and to move for papers.

Baroness Gould of Potternewton: My Lords, I am pleased to have the opportunity to introduce this debate on violence against women and girls. When I put the question into the ballot some months ago, I had little knowledge of the Government's intentions. The only reference in the coalition document related to examining ways of funding rape crisis centres from the victim surcharge. Not to take anything away from the invaluable work of rape crisis centres, but they cover only one aspect of an extremely wide and complex subject. I was surprised, having read a number of statements written by the Conservatives when in opposition. However, last November, the Government produced a policy document, Strategic Vision: Call to End Violence against Women and Girls. This answers some of the questions I would have raised, but certainly not all. Maybe we will hear more of the detail today and more will come when the action plan accompanying the strategy is issued in March; also, when we have the response to the Stern review into how rape complaints are handled by public authorities in England and Wales. I am pleased that the noble Baroness, Lady Stern, who is back from her holidays, is participating in the debate.
	It has been fascinating to put the Labour Government's cross-government strategy alongside this Government's strategy paper. There are parallels in concept although perhaps not in detail in respect, for instance, of prevention, reduction of risk, provision of support when violence occurs, the importance of partnership working, ensuring that perpetrators are brought to justice and the importance of the training of front-line staff. I also welcome the reference to international work, following the work already started by my noble friend Lady Kinnock.
	Before examining some of the details, I want to look at the breadth of the issue which any strategy has to respond to. Both of the strategies that were produced in 2009, and this Government's in 2010, use the definition determined by the UN Convention on the Elimination of All Forms of Discrimination Against Women that,
	"violence against women is any action of gender-based violence that results in or is likely to result in, physical, sexual and psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private".
	It is a pity that the Government have resorted to the inaccurate statement that it is the first time that a Government have agreed to work to a single criterion to eliminate violence against women and girls. The previous Government also adopted the wider criteria established at the 1995 UN Women's Conference in Beijing, which included violence resulting through the use of technology and through economic harm. This cohesive and co-ordinated approach ensures that violence against women encompasses but is not limited to, domestic abuse, including financial abuse, sexual violence, rape, exploitation including commercial exploitation, sexual harassment and bullying, pornography, stalking, trafficking, forced prostitution in adults, all child exploitation, female genital mutilation, forced marriages, and crimes said to be committed in the name of honour. There are many connections that can cut across all these forms of violence against women. Some seem to sustain it, while others indicate common impacts and consequences.
	While I appreciate that there is to be a review relating to prostitution and a new strategy on human trafficking, their non-inclusion in the Government's strategy sends out a negative message that these issues are not forms of violence against women and girls as others are and means that policies will be less effective, such as those which overlap between trafficking, sexual exploitation or domestic violence. For instance, a young woman in prostitution may have a history of childhood abuse, a recent rape, or violent boyfriend or pimp to deal with. All those connections need to be made.
	I have two other queries in respect of the strategy. While I appreciate the introduction of domestic violence orders, there is no reference to how, during the period that a ban is imposed on the perpetrator, the victim is going to be protected. I had hoped that the crucial review of the conviction rate for rape would have been reinstated, as in financial terms it will save only £441,000, which I have been told is the reason why it is being removed.
	Many research studies continue to find alarming and unwavering levels of violence against women and girls in the UK, and I make no apology for repeating the figures since awareness is a crucial part of achieving change. Some 33 per cent of girls in an intimate partner relationship aged 13 to 17 have experienced some form of partner violence. Every year, a million women experience at least one incident of domestic abuse-nearly 20,000 cases a week, and 3.7 million women have been sexually assaulted at some point since the age of 16. There are 377 cases of forced marriage, many under the age of 16, and 12 so-called "honour" murders a year. In 2003, there were up to 4,000 women trafficked for sexual exploitation. Some 20 per cent of women say they have experienced stalking. Sixty-six thousand women have experienced FGM, and it is estimated by FORWARD, of which I am patron, that 24,000 girls are at risk every year.
	Violence against women and girls will not be eliminated until the attitudes that excuse and normalise violence are challenged and transformed. For instance, 36 per cent of people believe that a woman is wholly or partly responsible for being sexually assaulted or raped if she is drunk and 26 per cent if she is wearing sexy clothes. One in five people think it would be acceptable in certain circumstances for a man to hit or slap a female partner. What I think is even more distressing is that one in two boys and one in three girls believe that in some circumstances it is all right to hit a woman or force her to have sex. It has to be made clear that the responsibility for any form of violence or abuse lies with the perpetrator.
	Early intervention is a vital part of prevention, and has been key to both strategies, setting out which attitudes are acceptable and which are not. Schools and other institutions such as children's homes are important in challenging the formation of violence and in fostering positive attitudes towards respectful and equal relationships. Prevention of violence against women and girls needs to be deeply embedded across all aspects of the school curriculum, policy and practices, which prompts me to ask if the guidance produced by the Labour Government for teaching and non-teaching staff continues to be circulated and used, and when we will get confirmation that SRE and PSHE are to be included in the schools' curriculum. For while the coalition Government's commitment to teaching sexual consent in schools is welcome, this is not enough to create a safe school environment for girls and to tackle effectively attitudes that condone and normalise violence against women.
	Equally, violence against women and girls must be a part of the work on sexualisation of children, child protection and parenting. Every day, all across the country, women and children are to be found in accident and emergency units, at doctors' surgeries, at sexual health clinics and drug and alcohol clinics bearing the impact of violence and abuse. The findings of the task force under Sir George Alberti, incorporating the focus groups undertaken by the Women's National Commission reinforced the importance of raising the profile of violence against women and girls, resulting in guidance being circulated to NHS staff. This was reinforced by the inclusion of violence against women and girls in the Operating Framework for the NHS in England 2010/11. Can the Minister assure the House that it will be a part of any new NHS operating framework?
	Violence against women cuts across every aspect of public policy and every department of government and local government. There are links between violence against women and fear of crime, rape, assault or stalking, creating the fear of going out at night. Cuts in street lighting costs which are being proposed by some local authorities will only exacerbate that fear. Similarly, big sporting events are a target for increased trafficking and sexual violence, which requires the co-ordination of services both nationally and locally. Perhaps we could hear how that has been achieved. There is clearly value in the Government's cross-government committee on violence against women, but can the Minister indicate its role and membership, and how it will work with local government and the third sector, which will bear the brunt of implementation at a time when they are experiencing budget cuts?
	As well as the long-term physical, psychological and social costs, violence against women also represents a significant cost to the economy-£40 billion per year. The direct cost of domestic violence in one year is £6 billion, the human and emotional costs being estimated at £17 billion and each case of rape is estimated to cost £76,000.
	The Government are to allocate in total £28 million for specialist services over the next four years, of which £20 million will be funding for the Multi Agency Risk Assessment Conference, and both sexual violence and domestic violence independent advisers, as well as the National Domestic Violence Helpline. However, the Government strategy refers to initiatives such as MARACs and the IDVA as services, but they are not services as such. Will the Minister clarify that statement?
	There is also a sustainable model of funding for rape crisis centres. However, no other women's services are included, particularly for the most vulnerable, and BME services are lacking in the policy almost entirely. It is also disappointing that there are no targets, milestones, measurements, monitoring and so forth in the document, but again, can we expect them to appear in the action plan?
	Violence against women is not inevitable. In 2002, the World Health Organisation's ground-breaking research World Report on Violence and Health found that,
	"violence can be prevented and its impact reduced ... The factors that contribute to violent responses-whether they are factors of attitude and behaviour or related to larger social, economic, political and cultural conditions-can be changed".
	That means that the prevention of violence against women requires identifying and challenging the root causes and drivers of violence against women, be it the unequal power relations between women and men, including gender inequality in social, cultural, economic and political spheres or the persistence of rigid gender stereotyping. Such interventions to address violence against women will be effective only if they are part of an embedded prevention strategy that challenges broader attitudes, practices and unequal power relations between women and men.
	Leadership at all levels is needed to strongly challenge violence against women and to promote non-violent norms and respect for women. In addition to high-level political leadership, community mobilisation and leadership at a grass-roots level is important for transforming attitudes and driving social change at local level. I am proud to have been involved in my own local community in Brighton and Hove for some years now, where we have been doing that work. That means increasing the capacity of women's services, providing resources for women-only services and local communities to challenge violence against women at a local level and develop models of community-based prevention of violence against women.
	Therefore, the prevention of violence against women needs to be located in policy frameworks that promote gender equality and tackle unequal power relations between women and men We must ensure that violence against women is included in the public sector equality duty objectives by public authorities under the Equality Act 2010, which I hope will be retained, and by regular public reporting on progress on key indicators of gender inequality-for example, the gender pay gap, gender division of paid and unpaid work, as well as women's representation in public decision-making.
	To summarise, violence against women is one of the main causes and consequences of women's inequality. It represents a violation of women's rights, including the right to gender equality and non-discrimination, the right not to be treated in an inhuman and degrading way, the right to respect for private and family life, including the right to physical and psychological integrity, and the right to life. It will only be by providing adequate resources, support mechanisms and the necessary machinery that the vision that I am sure we all seek of a society where women and girls can lead lives free of the threat and reality of violence can be achieved. I beg to move.

Lord Lester of Herne Hill: My Lords, it is a great pleasure to take part in this debate and I congratulate the noble Baroness, Lady Gould, on introducing a subject that unites the whole House. I am particularly pleased to take part in the debate because I do not see among the names of those who will speak any of the filibusteros who emulate Cato the Younger in deciding that the best way of obstructing the proceedings of the House is to talk on and on. This is a time-limited debate and, because on the whole women are more sensible than men, I expect that it will be as courteous as we have come to expect.
	Among those who are speaking are the noble Baronesses, Lady Greengross and Lady Howe of Idlicote, both of whom took part in the historic debate that took part on 26 January 2007, when this House united in seeking to obtain civil protection against forced marriage. The noble and learned Baroness, Lady Scotland, was not able to be here for that, but she of course had played an important role in developing the work of the Forced Marriage Unit and its guidelines, and in her absence the noble Baroness, Lady Ashton of Upholland, stretched the limits of ministerial collective responsibility in encouraging me in a Private Member's Bill and eventually in persuading the Prime Minister Tony Blair to reverse himself and support the Bill, which became law.
	I will deal with one matter that is raised in the Motion, which is about reform of the law, and suggest ways in which this country could use the Forced Marriage Act as a model for export within Europe and especially in the Indian subcontinent. The problems of domestic violence are of course not unique to any one country or religion, race or ethnic group. Because some of the aspects of domestic violence, such as the sexual grooming of young girls, children and so forth, have recently been linked with a particular section of the community, and because the right honourable Jack Straw has chosen to come out and say that this is a particular problem involving young Pakistani men, I want to emphasise that it is important not to indulge in ethnic or religious stereotypes. The problem of violence against women is an ancient problem that afflicts all societies, cultures and religions. You do not have to look to any one to stigmatise them. It is important that that should be said.
	Forced marriage is only one example-a gross one-of domestic violence at its worst. Forced marriage is a crime. It is not labelled as such but it is a crime when it leads to murder, kidnapping, abduction and offences against the person of one kind and another. I agreed with the previous Government-I am sure the present Government agree as well-that criminal law is not the best way of tackling problems of domestic violence unless one can prove a case to a jury to a criminal standard of proof, which is very hard to do. In this House, we managed eventually to persuade the Government and the other House to deal with it through civil protection instead of relying entirely on the criminal law.
	The advantage of civil protection and family law is that it does not involve any public dishonouring of families. It does not lead to victims being permanently separated from their families. It can be dealt with protectively and not punitively. It should diminish the problems by acting as a deterrent through contempt of court for those who violate the forced marriage protection orders. In this country, we have established a radical, new, innovative piece of legislation of which this House in particular should be proud.
	I also think that the Forced Marriage Unit guidelines are now superb and I commend them to any noble Lords who have not seen them. They are detailed, practical, well directed and have grown out of the work that was done by the noble and learned Baroness, Lady Scotland. The problem is that these issues transcend national boundaries. They cannot be settled in any one country. They require co-operation across frontiers and mutual assistance by governments, judges and legislators.
	At the moment within the Council of Europe-the 47 countries from Ireland in the west to Azerbaijan in the east-work is being done on a domestic violence convention. I am sure that the British Government are playing their part in that. My problem with the convention is that it emphasises criminal sanctions too much and does not sufficiently focus on the need for civil protection. I do not expect the Minister to respond to any of this today but I hope that those who are engaged in negotiating that convention will explain to our European partners the need for civil measures and not mainly a reliance on criminal ones. Within Europe we ought to be able to get not uniform but compatible civil protection measures in all 47 countries. That should be our aim under an umbrella convention.
	That is one bit. The other is to do with places such as the Indian subcontinent. Many of those involved in the problems of forced marriage and honour crimes are, because of the history of migration to this country, connected with India, Pakistan and Bangladesh. It is really important that we work with those countries' governments and judges to get matching legislation so that if, for example, a young girl or boy is taken to one of those countries fraudulently in order to be given a partner that they must marry, there are measures in those countries that allow them to co-operate with the authorities in this country to get the victim protected and back to this country.
	The noble and learned Baroness, Lady Butler-Sloss, managed to arrange a judicial protocol with the then Chief Justice of Pakistan, which you will find in a leaflet in the Foreign Office. Yet when I mentioned this to a Pakistani lawyer friend, she said that the trouble is that that initiative has never been put into legislation in Pakistan and has been treated as illegal. If that is the case, it is really important to persuade the Governments of Pakistan, India and Bangladesh and anyone else connected with the problem-but especially those countries because they are our good friends and neighbours in this area-to legislate, with legislation similar to ours. I am sure it can be done. It just requires some political will and initiative to do it. This ought to be, without being imperial, a major export. I hope that that part of reform will be taken seriously by this Government.

Baroness Howe of Idlicote: My Lords, I add my thanks to the noble Baroness, Lady Gould, for the opportunity to debate this important subject. I congratulate my noble friend Lord Lester-he is and has been my noble friend on all subjects to do with equal opportunities for many years-on what he has achieved on forced marriage. It is a great achievement and I am proud to have played a small part in the original debate.
	Your Lordships will have received excellent briefing and figures, put together with suggested priorities for action, from Amnesty International and the End Violence Against Women campaign. As they and the noble Baroness, Lady Gould, have said, one-in-three women around the world will have been so abused and in the UK alone, 3 million women a year will experience some form of violence. The direct economic cost of this each year to England and Wales alone is £6 billion with the human and emotional cost considerably higher, estimated to be no less than £17 billion, and quite apart from violence against women being seen as sexual discrimination and a legal violation of their fundamental human rights.
	However, we live increasingly in a global world and it is a significant step forward that considerably more attention is being paid at the international level to promoting a legal requirement to end this abhorrent form of violence. The noble Lord, Lord Lester, has said that it is an example of where a bit more action should obviously take place. The role of new institutions such as UN Women-your Lordships discussed that on Monday-is one such example. All this will help and eventually this violence will not only become internationally illegal but also, more importantly, be increasingly seen as a totally unacceptable form of human behaviour-but, and it is a big but, we are a long way yet from achieving that goal.
	We need also to be realistic, not least at a time when all countries face degrees of severe economic hardship. It would seem obvious, for example, that third world countries will take longer to achieve such a goal than developed countries. In parts of the world where conflict or environmental disasters have struck, progress will inevitably be limited or non-existent without much more external support. In environmental disaster areas, the example of Haiti is all too relevant. Hundreds of cases of rape and other forms of sexual violence have been reported in the camps during the past year, with organisations working on the ground believing that these are really only a fraction of the true number of women and girls who have experienced violence. Shamefully, it remains all too clear that in any conflict area it continues to be the unspoken but accepted view that the right to rape women and children is part of a "reward" for successful armies. That disgraceful situation needs a far higher international profile together with the determination to eliminate such behaviour.
	Apart from our international role to promote the whole issue-I am sure other noble Lords will mention the importance of that-we surely have a duty to set a firm example here in the UK of what can be achieved. Yet there remains far too much domestic and other violence in the UK. The internet's existence may mean that the amount could be increasing. Your Lordships will recall recent court cases-they have been referred to already-of organised gangs of young men grooming very young women via the internet and I will not go further into that. However, the Government are certainly to be congratulated on having published two months ago their strategic vision, Call to end violence against women and girls. We all look forward to hearing their strategy and priorities for achieving this, due out I believe in March. I hope the Minister will be able to give us some hints about how this is all developing.
	Like other noble Lords, I, too, have a wish list of issues that I hope will be included but above all I could not agree more with the noble Baroness, Lady Gould, that education of the rising generation must be a priority and the earlier it all begins the better. Some schools-they tend to be the equivalent of not private but voluntary schools-have succeeded with pupil mentoring of new recruits from nursery school upwards and firm stands have been taken against any forms of bullying. That needs to be spread much further. The noble Lord, Lord Northbourne, was here a moment ago but has disappeared. With him, I was hopeful that the previous Government's legislation for citizenship would enable genuine discussions about what parenthood involves to be gone through with the younger generation so that they have a much clearer view of their role in that respect. This should be a high priority now and in future in all schools.
	We should not forget either the progress that has been made and when more is achieved things will improve further. Equal pay and more and wider job opportunities have not yet been totally achieved but there has been progress. A lot of this has helped to give women more confidence and money to leave abusive partners if that becomes necessary. More flexible work patterns will also help give more financial freedom as well as time with their children for both parents to develop satisfying, long-term relationships.
	I end with two brief points about the need for us all to look carefully at the role of the media in all their forms-particularly, perhaps, the role that the internet plays. Knowing that the material we listen to and watch is not only viewed at home and at work on TV sets and computers but on machines that we all carry around in our pockets throughout the day and night, the first point is the extent to which all our broadcast media have become increasingly frightening and dramatic-even violent-in the drama and social issues that they cover. Noble Lords will certainly remember the recent bloodcurdling screams from "The Archers" but I am certainly thinking also of television soaps and much more, which we all see on television these days.
	When I chaired the Broadcasting Standards Council, the watershed was still more or less observed but, again, with the 24-hour impact of the internet there is, in effect, no watershed these days and self-regulation by broadcasters reigns. It is almost as if the public appetite not only demands but, increasingly, is being fed frightening and aggressive material on an escalating scale. My concern is that this is unlikely to be soothing any potentially aggressive or violent behaviour. Those of us who do not believe that what we see and watch on television does not have an influence on us are an increasingly diminishing number. Anyhow, I hope that the Minister will take this back with her, think about it and, perhaps, have discussions with Ofcom about whether there is something more than we can be doing here.
	My second point is more specific and will be briefer. It concerns the increasing need in this internet-dominated world to protect children from early contact with pornography and other forms of violence. I frequently raised this issue with the previous Government during the consideration of media legislation. All media equipment needs to have easily understood parental guidance on how to prevent children accessing this material. We must never forget that our children are always much more expert at these things then we are ever likely to be.
	There is also, one feels, the need for more action at an international level. I really do not know and have not had the time to look up whether UNESCO or anybody else has, rather than just the ability to influence in this area, more specific responsibilities or powers. Internet service providers have some responsibility for checking that those wishing to access that kind of material are indeed adults, but should they have more responsibility? Perhaps someone could look at that. I know that some rules exist which should prevent the use of children in pornography and, to some extent, those are much more likely to be firm. Again, however, we all know that there is quite a lot of this stuff around even if it is more protected in certain ways.
	It would be reassuring if the Minister could look at this whole area as part of the Government's strategy in looking at how to get rid of violence against women and children in the future.

Baroness Massey of Darwen: My Lords, I thank my noble friend Lady Gould for introducing this debate. She also deserves thanks for all her work on behalf of women, in particular vulnerable and disadvantaged women. It is also good to see the noble Baroness, Lady Verma, responding. She, too, has long supported the principles of justice for women, whoever they are and whichever culture they belong to. My noble and learned friend Lady Scotland, especially in her previous role as Attorney-General, was also much concerned about issues relating to women.
	It has been pointed out that women are physically weaker and often more economically disadvantaged. They often lack power, so others exert power over them. As has been said, violence against women takes many forms, be it rape, female genital mutilation, torture, forced marriage, beatings or other physical and psychological harm. On FGM, my noble friend Lady Rendell, who has involved herself with this outrage for many years, unfortunately cannot be here, but continues her efforts. I shall make a few introductory comments and then focus on women who are trafficked.
	Some statistics have been given but they may be worth emphasising. Over 1 million women are victims of domestic abuse each year; over 300,000 women are sexually assaulted each year; and 60,000 women are raped each year. According to Women's Aid, 70 per cent of teenage mothers are in a violent relationship. All this has economic fallout. Violence against women costs the NHS about £1.2 billion a year for physical injuries, with an added £176 million for mental health care. Among women aged between 15 and 33, acts of violence cause more death and disabilities than cancer, malaria, traffic accidents or wars combined.
	It is therefore gratifying that Theresa May has launched a plan to focus on violence against women. Like many others, I look forward to seeing the action plan. I understand that the Government's ambition is to have increased awareness of violence against women and girls. I am not sure how that will be measured but, like my noble friend Lady Gould, I would like to see education programmes in schools for girls and boys to counteract violence against women. There are financial implications in tackling violence against women, of course, but I hope that the Government will take into account the costs involved in not tackling it as well. I do not mean just the financial costs.
	The trafficking of girls and women, in the UK but also elsewhere, is surely one of the most horrible of crimes against women. Again, the statistics are shocking. At any time, over 140,000 people are victims of trafficking. Of these, 84 per cent are trafficked for sexual exploitation and the majority of those are women. I want to ask the Minister again about the EU directive on human trafficking, an issue that has been raised before with the noble Lord, Lord De Mauley. This directive was voted in by the European Parliament by 643 votes to 10, with 14 abstentions, in December last year. I am aware that many British MEPs supported the directive. Just before Christmas, the noble Lord, Lord De Mauley, told a group of interested Peers that the Government would review their position once the directive was agreed. What is the current situation with regard to this directive and can those interested Peers be informed?
	I go back to the impact of the trafficking of women and girls in Europe. A devastating report, Stolen Smiles, was published in 2006 by the London School of Hygiene and Tropical Medicine. I cannot go into all its details but they are chilling. Women were trafficked to 24 different countries, including 53 per cent to EU member states. Forty-two per cent of this group were between 21 and 25, the youngest being 15 and the oldest 45. Sixty per cent had been subject to some sort of violence before they were trafficked and 90 per cent had experienced sexual violence. Forty-four per cent had been tested for sexually transmitted infections, 17 per cent had had an induced abortion and 38 per cent reported having suicidal thoughts because of what happened to them.
	Yet some victims of trafficking are prosecuted for crimes that they have been forced into doing. ECPAT UK, the umbrella organisation on trafficking, reports the case of three young Romanian women who had been trafficked for sexual exploitation. The trafficking was suspected by relevant agencies in Manchester but the women were prosecuted and spent time in prison on a charge of prostitution. This surely needs to be looked at. Perhaps the noble Lord, Lord Lester of Herne Hill, could employ his many talents in looking at that as well.
	In 2008, the Association of Chief Police Officers, led by North Yorkshire Police's Chief Constable Grahame Maxwell, set up Project Acumen to try to better understand the nature and extent of the trafficking of foreign nationals for sexual exploitation. It concluded that the nature of trafficking makes it difficult to measure or estimate-it is a kind of covert issue. About 6,000 trafficking businesses and 30,000 women were involved in prostitution. There are large profits to be made and unreasonable control over victims is exercised, such as threats to families, debt, fear, shame and religious or cultural mechanisms. Trafficking is not smuggling; it is exploitation, and many of the victims are women. The exploitation is, of course, not just about sex. It may also be to do with employment practices.
	A 2009 report by Eaves Housing for Women on trafficking and contemporary slavery in the UK points out that Governments of destination countries are often hesitant to address trafficking as a crime that violates vulnerable people because they see migration into those countries as always being desirable. It is not. The report also points out that the sexual abuse and rape of migrant domestic workers is common but underreported. The disclosure of such abuse is used as a threat by employers who know what impact this would have on the workers. Many would be unable to return to their families because of social and familial shame and stigma. What work is going on between the UK and countries from which people are trafficked to combat some of these problems?
	A number of campaigns are under way in relation to violence against women. A number of dedicated individuals are involved in combating such violence. The UN Trust Fund is supporting programmes to support country-level efforts. I know that we shall all follow the progress of UN Women, which became operational this month. It has been referred to already and my noble friend Lady Prosser recently asked an Oral Question on the issue.
	It is clear that violence against women is entrenched and that many women are locked out of economic and political engagement. This is not just about discrimination; it is about power and exploitation. I hope that this debate and all the issues that have been raised in it will be taken note of and that violence against women will return again and again to the agenda of this House.

Baroness Hamwee: My Lords, I, too, thank the noble Baroness, Lady Gould, not just because she has given us the opportunity to discuss this wide-ranging subject but because of the importance of raising awareness of violence against women generally. I want to talk particularly about domestic violence and raising awareness of it.
	For some years I was the chair of the board of Refuge, the domestic violence charity. In that capacity, I attended quite a number of events with different groups. On every one of those occasions, at which you can see people because you are standing at the front and facing the group, I was aware of at least one woman in the room who, with her expression and her body language, indicated that she was personally affected, although she would never say so. I often read the reaction as shock as she listened and as a sort of revelation-"This is not something that is happening only to me", and, importantly, "What is happening to me is not my fault". There is a need for awareness of the violence behind closed doors; it is private violence, but it is an issue for the whole of society.
	My noble friend Lord Lester said that he welcomed this debate because women are civilised when we debate. Indeed we are; I do not take issue with him on that. I am not surprised that my noble friends Lord Lester and Lord Thomas are taking part in this debate. I wish that other male Members of this House were contributing as well-perhaps next time.
	The Motion refers to services. This point applies more widely than just to services dealing with violence, but I want to draw attention to telephone and internet services. It is often much easier, for many reasons, to seek help initially on the telephone. There may be practical reasons for that, although sometimes it takes an awful lot of organisation and care for a woman in a difficult situation to use a telephone. However, emotionally, as well, it is sometimes easier to express oneself when one is not face to face, because the human voice is such a powerful instrument.
	I know of the demands that were placed on Refuge and those who worked for it, often in a voluntary capacity, in maintaining a helpline some years ago. A lot is owed to them and to the helpline sponsors. The establishment of the 24-hour national domestic violence free phone helpline, run in partnership between Women's Aid and Refuge, was not without its difficulties, but it was a good decision by the Government to support and fund it. Telephone helplines-in this case I have stressed 24-hour, national and free-and web-based services, to which the point also applies because increasingly people turn to the internet, are essentially not local. We are currently focusing very much on localised services, and I share in acknowledging the importance and effectiveness of services designed to meet the different needs of different communities. Sometimes those communities may be local, but helplines and internet services are not local services in the same way. They do not lend themselves in the same way to local organisation or, therefore, to local funding. I think that what I am saying is that not everything can be localised.
	My third point is, in a way, more technical but it illustrates how society still needs to work towards recognising the extent-I think that I mean both the breadth and depth-of violence against women. I ask the Minister to take back the issue of introducing a criminal offence of liability for suicide, which would apply to cases in which the victim of cumulative abuse is ultimately driven to suicide. According to the British Crime Survey, 3 per cent of victims of domestic abuse in 2008-09 tried to kill themselves.
	One woman who succeeded, in 2005, was Gurjit Dhaliwal, who suffered 25 years of abuse from her husband. It started, as so often it does, with controlling behaviour-"Don't go there, don't talk to that person"-and isolation from her family and it became physical when she was pregnant with her first child. Following a particularly brutal attack she hanged herself. She was found by her youngest son. Mr Dhaliwal was acquitted of manslaughter because the psychological harm that his wife had suffered did not fall within the definition of recognised psychiatric illness and therefore could not amount to grievous bodily harm. There is a distinction, and there was bound to be one, between psychological injury, which the court found in Mrs Dhaliwal's case, and psychiatric harm.
	I know that the Government are aware of this issue. In 2009, for instance, ACPO, in a review for the Home Office on tackling the perpetrators of violence against women and girls, considered whether there should be a new homicide offence of liability for suicide and whether this should be created particularly with regard to relationship-based violence, including domestic abuse and, of course, so-called honour-based violence. The chief executive of Refuge, Sandra Horley, has discussed this with the Home Secretary. With two such eminent lawyers sitting in front of me, I am hesitant to bring this into the debate, but I am asking for serious consideration of the issue. I am certainly not seeking to provide a prescription at this point. I am conscious, too, that before the election my party argued that we had too much legislation and that too many criminal offences were created when there was already an offence on the statute book. This does not fall within that category.
	I attended my first board meeting of Refuge on the day when I was asked if I would be prepared to become a Member of your Lordships' House. That was 20 years ago. In those 20 years we have seen huge advances in how the issue of domestic violence is dealt with, but we still have a long way to go.

Baroness Greengross: My Lords, I shall look briefly at the situation in this country and then concentrate on older women and widows of all ages in many countries across the world. I add my congratulations to the noble Baroness, Lady Gould, who does so much to champion the cause of women at all times. It is a privilege to take part in this debate.
	We know, as my noble friend Lady Howe clarified, that 3 million women experience violence every year in this country and that many more live with the legacy of abuse that they experienced in the past. We know that violence can also cause lasting psychological damage and that sexual offences bring the risk of HIV, other sexually transmitted diseases and forced pregnancies. Following that, I am sure the Minister is aware that it is estimated that violence against women costs this country £40 billion every year. From a purely economic perspective, let alone on any moral or societal grounds, the rising incidence of violence against women is totally unsustainable. I add my voice to the others here today that seek urgent action on all aspects of this important matter from the Government.
	I turn to older women. Figures were produced by Help the Aged some time ago, in 2004, which showed that 20 per cent of elder abuse reported on its helpline was physical. Forty-four per cent of people calling the helpline reported more than one type of abuse occurring simultaneously. The vast majority-67 per cent-of people who reported violent abuse were women. The main recommendation following that report was that a comprehensive prevalence study was needed to establish the extent and impact of elder abuse throughout the UK. I could not find this report so I am not sure whether the prevalence study ever took place. I ask the Minister whether the Government have any plans to undertake a survey of this type or, if it has been done, to update the existing figures. This would help enormously, enabling us to eradicate a particularly disturbing form of violence.
	I turn to the violence experienced by widows in particular. Of all the different categories of women affected by violence, this one is particularly vulnerable, but it is also notably ignored by Governments and the international community. Although there is very little research or data, we know through NGOs-in particular, I know through Widows for Peace through Democracy, to which I am most grateful for briefing me-that millions of widows of all ages, including wives of the missing and their daughters, suffer extreme forms of physical, sexual and psychological violence at the hands of both family members and the community at large. For example, in Africa, widows may be victims of harmful traditional practices, such as mourning and burial rites, including ritual cleansing by sex; forced widow inheritance, where a widow is forced to remarry with a husband's relative; and violence meted out in the context of inheritance and property disputes.
	However, the worst violence to widows occurs in conflict and post-conflict environments. Widows and their daughters are often targeted for rape, sexual mutilation and forced prostitution since they have no man to protect them as they struggle to survive. In the Democratic Republic of Congo, Burundi and Sri Lanka, for example, this has been very noticeable. In Sri Lanka, more than 31,000 Tamil widows are aged under 30 and many of them are gang raped. In the DRC, hundreds of thousands of widows are rape victims, as they were in Rwanda during the genocide. In Nepal, many young widows of the conflict have been raped by their male relatives. In Kosovo, Bosnia, Iraq and Afghanistan, widows are still the poorest of the poor and routinely targeted for rape and forced prostitution. In many countries in Africa we know that widows are killed as witches, particularly in relation to the AIDS pandemic. In Afghanistan and Iraq, which I have mentioned, widows-increasing in number on a daily basis-experience violence, especially sexual violence, within and outside the family.
	This issue is important because, as we know, these widows are the sole supporters of families and future generations, and they have an important role to play in development and peace-building. They need to be protected from violence so that they can care for and educate their children. We have already heard about the huge importance of education.

Lord Judd: The noble Baroness makes a profoundly important point. Would she agree that one of the grave implications of what she is talking about is that there is increasing evidence that violence against women is being used as a deliberate war weapon in conflict, as is rape? The trouble is that international law has not yet recognised this.

Baroness Greengross: I thank the noble Lord for that comment; I agree completely. I hope that the whole House will agree that this is an important issue which should be prioritised in our policies-for example in relation to our national action plans for the implementation of UNSCRs 1325 and 1890, which concern sexual violence against women in war. I agree completely. I hope the Minister can assure me that the Government will ensure that this issue is a priority that will not be overlooked.

Lord Thomas of Gresford: My Lords, it was a sunny Sunday morning in the middle of the summer of 1971. I had spent the morning drafting seven divorce petitions. It was, I have to say, depressing and oppressive. At lunchtime I gave my wife a cuddle and said that I could not stand it any longer: I was not going to do this work any more-and I did not. As your Lordships will appreciate, that day is firmly fixed in my memory. I had had 10 years of it. As a solicitor you are very much closer to the client. As a young solicitor listening to women who had been attacked by their husbands or partners, I realised then what a terrible problem domestic violence was.
	Later I was involved in many murder cases that involved domestic violence. The ones that stick out in my mind are those where women reacted to the abuse they had suffered over years. There was a lady who put a hammer through her husband's head when he was asleep, dragged his body into a back room and brought up her family for 20 years before the body was found. She received an absolute discharge. Another lady put a knife underneath a pillow on the sofa, took her husband out and got him really drunk and killed him when they got back. She was given a conditional discharge. I recall a third lady who, after years of abuse, reacted when her husband refused to come through for the dinner she had prepared for him. She picked up the bread knife, looked at it, put it down, picked up the carving knife and killed him. She was given a suspended sentence of imprisonment.
	These cases occurred in the 1970s and 1980s and I take no credit for them, because I was prosecuting in each one, but they indicate that there were at that time humane judges who imposed humane sentences and were aware of the issues involved. Those sentences would be impossible in the climate of sentencing that has existed over the past 10 or 15 years. What lessons did I learn from this experience? There were some real psychopaths who enjoyed inflicting cruelty and pain. I remember that one man tied his wife to a chair and left her for three days in that position. But more often, faced with another sentient being, sometimes a dependant with needs and wants to be fulfilled and sometimes a person of superior intelligence and ability, many men are at a loss how to behave. Very often they have grown up without role models. As the noble Baroness, Lady Howe, pointed out, perhaps they take their models these days from violence that is portrayed in the media or, even worse, from pornography which is so freely available on the internet.
	These are the last chapters in a matrimonial or other relationship but it is the first chapter that really counts. The Department of Health statistics show that 750,000 children witness domestic violence each year, and most of them do not share that experience with others. These are the closed doors to which my noble friend Lady Hamwee referred. In Wales we have a number of initiatives: the Children's Commissioner; MARAC, the Multi-Agency Risk Assessment Conferences, which started in Cardiff; and the current education policy of the Welsh coalition Government, which is well in advance of that in England. Personal and social education is a compulsory part of the education curriculum in Wales. The Welsh coalition Government put into effect explicitly the United Nations Convention on the Rights of the Child. Each school must agree a personal and social education policy which will include sex and relationship education and must be delivered by a senior member of staff.
	PSE and CWW-careers and the world of work-are mandatory components of the Welsh baccalaureate qualification, the WBQ. They are core studies. Learners are obliged to study four elements of PSE and undertake community participation. In Wales this is seen as an opportunity to explore social issues with young people just as they begin to form relationships with each other. The guidance given in a document entitled Personal and Social Education Framework for 7 to 19-year-olds inWales, published in 2008, states that learners should be given opportunities to develop a responsible attitude towards personal relationships; to understand the range of sexual attitudes, relationships and behaviours in society; to understand the importance of sexual health and the risks involved in sexual activity, including potential sexual exploitation; and to learn about the features of effective parenthood and the effect of loss and change in relationships.
	Girls should be taught that domestic violence is never acceptable or justified, so that they will react if they are subjected to it. Boys must be taught what is acceptable behaviour, how to respect a partner and to learn about that give and take of a partnership which is the foundation of a stable home in which children can be taught values that will see them through their lives. Investment in education at this stage saves money in the long term on healthcare, lost days of work, criminal justice involvement, housing difficulties and other social problems. I cannot understand why the previous Government allowed the amendment that was introduced in the previous Session of Parliament to be dropped in the wash-up as it would have permitted similar compulsory education to be introduced in England.
	Healthcare professionals have a great deal to say in this area. It is said that one-third of violence against women begins when they are pregnant. I do not know why that should be. Are they physically and emotionally vulnerable at that time? It is the policy in Wales that midwives should on a number of occasions-more than once-question a pregnant woman about any concerns that they may have at home in order to satisfy themselves that there is no background of domestic abuse which may harm the mother or the newly born child. That should be extended to other healthcare professionals such as nurses in accident and emergency departments who may have the opportunity to speak to the patient alone after an incident. Training takes place in some hospitals but there are sensitivities in involving health professionals in the detection and investigation of offences.
	The Sheffield Domestic Abuse Partnership Case Study is a new project that was set up in May 2010 because,
	"the pathways for support for victims of domestic abuse were unclear and confusing".
	This project has grouped together a helpline, domestic violence advisers, outreach workers located in a hospital maternity wing, police domestic violence officers, social workers and youth offending service officers. I shall be very interested to read that study when it reports. It surely is the way ahead.
	Specialist domestic violence courts have been successful but they are not rolled out across the whole of the country. Seventy-three per cent of domestic violence is repeat offending, with 27 per cent of victims attacked three or more times according to a progress report published in 2007-08. However, a woman will have been beaten many times before she involves the criminal justice system in the first place, which illustrates the strength of the points made by my noble friend Lord Lester. Home Office and academic studies establish that domestic violence accounts for between 16 per cent and 25 per cent of all recorded violent crime-up to a quarter of it results from domestic violence.
	Specialist domestic violence courts have increased the number of convictions. However, the problem in these proceedings is keeping the victim on board as a witness. The courts provide specialist teams who are committed to cases being dealt with swiftly. This lessens the stress for a victim called to give evidence and decreases the opportunities for an abuser to stretch out the proceedings in the hope that the victim may be deterred from giving evidence or the chances that the defendant and victim may be reconciled by the time of trial with the victim retracting her statement. There is a disparity in the number of witnesses in domestic violence cases who retract their statements or refuse to attend court as compared with mainstream cases.
	In a paper entitled Call to End Violence against Women and Girls, which has already been referred to, my honourable friend from another place, Lynne Featherstone, the Parliamentary Under-Secretary of State for Equalities and Criminal Information, said:
	"We need to do, not simply talk about doing".
	I commend her determination to make a real difference to women and girls who have suffered or are at risk of suffering violence, to ensure that they can achieve their full potential and live fulfilled lives.

Baroness Stern: My Lords, I, too, thank the noble Baroness, Lady Gould, for initiating this debate and for encouraging me to participate at rather short notice. It will come as no surprise to noble Lords that I will concentrate my remarks on matters to do with rape.
	Rape is of course mainly, although not exclusively, directed against women, and is one of the most serious, invasive and damaging aspects of violence against women. The work that I carried out for my review involved meeting a number of rape victims and listening to what they had to tell me. That made clear to me how damaging rape is and how long lasting its effects are. The report of my review was published last year. Therefore, I will look at some of the developments since then-most of them positive and welcome-as well as seek some guidance from the Minister on where she sees this work going.
	Let me start by saying how welcome is the approach that the Government have taken in the document, Call to End Violence against Women and Girls, which agrees on the need for a broad response. Criminal justice is undoubtedly important, but equally important is prevention and support for the victims. I also welcome the way in which the Government have set the discussion in the document within the framework of international norms and standards on women's equality and the Government's obligations under those international instruments, which were listed comprehensively by the noble Baroness, Lady Gould. People who have suffered serious violence are entitled to support and help. That is not a favour or a charitable act but a right.
	Moving to specific points, I think that one of the major issues surrounding discussion about rape is the question of outcomes in the criminal justice system. In that context, I shall first mention some steps that have been taken by the Ministry of Justice to ensure that the information in the public domain about how rape is dealt with is more useable and comparable than has been the case to date and is less likely to lead to misunderstandings and ill-informed argument. Alongside the announcement of their sensible decision not to proceed with providing anonymity to defendants in rape cases, the Government also published a report that pulled together research evidence. I was glad to have the opportunity-pre publication-to advise on the report. The report, Providing anonymity to those accused of rape: An assessment of evidence, gives for the first time a breakdown of the outcomes in rape cases that come to court.
	I want to get those figures on the record, because the more widely known they are, the more likely it is that victims will feel, first, that it is worth reporting what has happened to them and, secondly, that it is worth staying with the process, even though it is lengthy and can be painful. The Ministry of Justice researchers carried out a one-off analysis that found that, of all the 2007 rape cases where the trial was completed by the end of 2008, 42 per cent of defendants were found not guilty and 58 per cent were convicted of an offence, of which 34 per cent were convicted of rape, 17 per cent of another sexual offence, 3 per cent of another violent offence, 3 per cent of another indictable offence, and 1 per cent of a summary-that is, a minor-offence. Thus, 54 per cent were convicted of rape or another sexual or violent offence. This is new information and it is important that we have been provided with it.
	I also welcome the report's statement that,
	"the MoJ have been working with the National Statistician to explore fully the issue of conviction rates in rape cases ... a wide consultation on full proposals for the measurement of conviction rates in statistical bulletins across all offences is planned".
	This is particularly welcome because we shall at last be able to compare rape outcomes with those for other serious violent offences. I am very grateful to the research and statistical staff at the Ministry of Justice for the hard work that they have done in beginning to sort out the confusions over outcomes in cases of rape.
	The research report also looked at evidence on false allegations and announced a welcome piece of work that will look at the extent and nature of false allegations. That work,
	"will help further knowledge about the circumstances under which false allegations of rape are made, and how these compare to false allegations made of other sexual and violent crime. It will also help shed light on what happens to those proven to have made false allegations".
	I particularly welcome the decision to undertake that piece of work. When I was carrying out my review, I found the matter of false allegations particularly concerning. Perverting the course of justice by making a false allegation of such a grave crime is serious-there is no doubt about that-but in some cases that I came across there was an anxiety about the surrounding circumstances, about the vulnerability of the accuser and about the level of culpability that suggested a more reflective approach might be appropriate. Noble Lords may have read about the case of the abused woman who retracted her report of rape under pressure and was jailed for making a false allegation, although she was subsequently released by the Lord Chief Justice. It is therefore much to be welcomed that the Director of Public Prosecutions announced in a recent statement that interested parties would be consulted about producing new guidance that in future the Crown Prosecution Service will consider before such cases are prosecuted.
	I will move on quickly to the question of serious violence against street prostitutes. One of the most remarkable discoveries that I made in the course of the review was that much superb work is being done by a range of people to protect street prostitutes from violence and serious assault and to take the necessary steps to prosecute and bring to trial those who carry out such assaults. At the end of last year, I was privileged to attend a big meeting organised by the Metropolitan Police, at which specialist police from Liverpool, and the outstanding women who work as specialist independent sexual violence advisers with street prostitutes in Liverpool, were invited to share their experiences of the best way of convincing street prostitutes that it is worth reporting assaults and of helping them through the criminal justice process.
	In that connection, I will mention a scheme called ugly mugs, which aims to collect intelligence on those likely to perpetrate violence against prostitutes and circulate the information to those likely to be harmed. After a pilot scheme, a plan for a national scheme has been put forward by the UK Network of Sex Work Projects, as there is evidence that such perpetrators tend to move from one city to another. Are the Government looking favourably at supporting the idea of a national scheme to take forward this valuable work?
	Finally, I very much welcome the announcement by the Government of continued funding for sexual assault referral centres and independent sexual violence advisers. At the end of last November, I was happy to travel to Ipswich to cut the ribbon at the opening of the first sexual assault referral centre in Suffolk, which brings together the police, local authorities, health authorities and the voluntary sector in a co-ordinated effort to provide a complete service to rape victims of all ages. The opening of the centre was the outcome of years of hard work and a most heartening occasion. Therefore, I ask the Minister, whose commitment to this work is unswerving, to confirm that the Government are firmly behind the continued development of such centres to make them available as of right to every rape victim who wishes to attend one.

Baroness Prosser: My Lords, I join others in thanking my noble friend Lady Gould for placing on the Order Paper this debate, in which I am particularly pleased to be able to participate.
	There was a time when violence against women-and domestic violence in particular-was scarcely discussed. Domestic violence was part of life for many women, and nobody thought too much about it. It was either too shameful or simply a fact of life. Many of us will have heard of the ancient law that allowed a man to beat his wife with a stick as long as it was no thicker than his thumb. Happily, things have moved on and we now express our horror of, and opposition to, all kinds of violence against women and girls. Many individuals and organisations have worked tirelessly to persuade Governments of the need for a funded, strategic approach that will eventually eliminate this dreadful blot on our landscape.
	Despite all the good work and expressed commitment, the violence continues. We have heard a number of statistics thus far, to which I will add a few: 1 million women every year experience at least one incident of domestic abuse-that is 20,000 women every week-and, on average, two women die every week at the hands of a violent partner. The problem starts young. We have already had statistics and information about the attitudes of teenagers. According to research conducted by the NSPCC, 43 per cent of teenage girls believe that it is acceptable for a boy to be aggressive towards his partner. It has already been said that education needs to play a much greater role.
	What else can we do? I declare an interest as the deputy chair of the Equality and Human Rights Commission. In its triennial review laid before Parliament in 2010, the commission identified five major objectives, one of which was that society should aim to put an end to identity-based violence. The commission said that we should:
	"reduce incidence of hate crimes on all protected grounds and increase conviction rate ... raise the rate of rape convictions further"-
	the information from the noble Baroness, Lady Stern, is of great interest in that regard. Thirdly, the commission said that we should,
	"reduce the rate of repeat domestic violence offences".
	It is also worth noting that, under the Equality Act 2006, the commission has a remit to use its powers to work towards the elimination of prejudice, hatred and hostility against equality groups.
	Like others, I was pleased to see the previously mentioned report of Her Majesty's Government, Call to End Violence against Women and Girls, but I am concerned that the express commitment in the document will be rendered unworkable or undeliverable by other, separate government policies. For example, page 7 of the document states:
	"The majority of services for victims of violence against women and girls are delivered at local level. We will support local areas to deliver the services that are right for their communities by stripping away unnecessary central government targets and initiatives ... Between now and 2013/14, we will also radically change the way these services are commissioned and delivered and encourage the involvement of local communities in deciding which local priorities should be funded".
	First, how can local authorities expect to continue to deliver the required level of service, given the major cuts to local government funding? Secondly, I would be keen to know how a local debate on spending priorities-making choices, for example, between care for the frail and elderly versus money for domestic violence-would pan out. I could hazard a guess that domestic violence would not come off very well. Further, have the Government considered the possible impact on family life of forthcoming benefit cuts?
	I am keen to make clear that I do not for one moment believe that domestic violence is confined to, or more prevalent in, households at the bottom of the financial ladder. It is correct to say that lack of money or uncertainty about whether the rent can be paid or whether the electricity meter can be fed places a huge strain on family life and can make a fragile situation collapse completely. Also, with no access to financial help, a woman cannot leave a violent family home.
	I turn to the UK Government's international responsibilities, which have already been mentioned. We have signed up to CEDAW, which monitors the UN Convention on the Elimination of All Forms of Discrimination against Women. On Monday in this Chamber, I was assured of the Government's commitment to the UN office for work on gender-UN Women-but I was no clearer at the end of the Question and debate what that commitment means when translated into hard cash and practical support.
	Women in many areas of the world look to countries such as the United Kingdom to come to their aid to help to save them from what can be appalling atrocities. Rape and mutilation are a daily occurrence in the Democratic Republic of Congo-a misnomer if ever there was one. There are so-called cultural practices that leave women with no rights to leave a violent partner or to reject forced marriages and female genital mutilation. If we are to consider ourselves as civilised and sympathetic to the plight of those women, words must be turned into action and must be backed up by the strategic allocation of appropriate resources. UN Resolution 1325 gives us the mechanism to deliver a better life for many women and girls who are currently suffering so badly, who feel abandoned and who are indeed victims of rape and violence as a weapon of war.
	I am pleased to see from the previously mentioned government report that the role of champion has been created to ensure the coherence of the Government's violence against women work with UN Women. I shall be keen to hear how this work progresses.

Baroness Walmsley: My Lords, I, too, thank the noble Baroness, Lady Gould, for introducing this debate. She has been an untiring campaigner on these issues, and long may she continue. It has been a very wide-ranging debate, and I hope to widen it even further with my small contribution. Earlier this week, I was very saddened to see on the front page of one of our national newspapers the face of a nine year-old girl. I think that Christina was her name. She was shot in Tucson, Arizona. She was born on a day of international violence, 9/11, and she died in a hail of bullets. The extremes of her life, the beginning and the end, were defined by violence.
	That reminded me, if I needed any reminding, that, for many children, violence is a way of life. I want to concentrate on the early part of life in my contribution today. I believe that prevention is better than cure. We all know that it is more difficult and more expensive to put things right once they have gone wrong. I believe that violence occurs when people do not respect each other, do not know how to react and are unable to react sensibly to stress, so they resort to anger and violence.
	There are many ways in which we can address those problems. I think that we must go right back to the very root of the problem. My noble kinsman mentioned the maternity unit, and that is not too early. As I have mentioned before in your Lordships' House-I hope that I will be excused for mentioning it again, because it is very important-research has shown that a major factor in the development of all violent tendencies lies in the structure of the developing infant brain. Early patterns are established, both psychologically and physiologically, which affect brain formation, the development of personality and consequent reaction to stimuli for the rest of the person's life. At birth, there 100 billion neurones and 50 trillion synapses or connections between them, but by the age of three the number of synapses has increased twentyfold. Genes specify some of these connections, but others are the result of experience and are hard-wired by repeat experience. This is why the early experience of the baby is so vital and why early learned behaviour is so resistant to change.
	The young brain is extremely vulnerable to trauma, in particular, to stress, which causes the brain to be awash with cortisol, the stress hormone. Cortisol gets in the way of synapses being properly established. That is why it matters and why we need to avoid stress in young babies. Problems will arise from many situations, for example, from violence against the mother or the child. The problem may be pre-natal alcohol or drug abuse. It may be postnatal depression or failure, for some reason, to bond with the mother, the father or any primary carer. A child who has experienced these sorts of stresses will often grow up unable to deal with stress or to establish healthy relationships and may be easily provoked to violence. It is not necessarily his fault.
	That is why I welcome the fact that the Prime Minister has asked Graham Allen MP to produce a report about early intervention, which I believe will be published soon-next week, I think-and I pay tribute to him and those who have assisted him with his report. I also pay tribute to Iain Duncan Smith for realising the importance and value of early intervention. I look forward with eager anticipation to reading the report since I hope it will provide us with some of the ways forward to help deal with domestic and other violence at their roots, as well as with poverty, crime, ill health and lack of educational opportunity. I will judge the report, and I hope the Government will judge the report, on how early are the interventions it recommends and how rigorous the methodology used to select the interventions to fund. I hope the Government have put aside public money to invest in early intervention, since it will be a very good investment, but, of course, we must be sure that public money is being spent on the right things, so we must look very carefully at the report. I understand that there have been many submissions from experts emphasising the importance of the early years of life, and I wonder whether the Minister can tell me whether these submissions have been published because I would be very interested in reading them. If we as a Government have vision and if we are to be responsive to the mass of excellent research out there, we must tackle the roots of domestic violence with really early and proven interventions.
	That is why, despite economic constraints, we must continue to invest in family support. Strong families produce well balanced people with good emotional and mental health. Children learn to copy the behaviour of their parents, so we really need to put a full stop to physical violence against women and children in the home. A boy who is constantly being hit by his father and who watches his mother being hit by his father will think that is the normal thing to do, and when he grows up, he will probably decide to model that pattern and hit his partner, so we have to stop it at a very early stage.
	However, there is a lot that can be done in schools, and I would like to tell your Lordships about two experiences I had before Christmas. They both relate to programmes with teenagers that I think also have an important place in our armoury against domestic violence. One was a visit to Winchmore School in north London where I saw young people exploring issues of domestic violence in their drama class. At lot has been said in this debate about the attitudes of teenagers, but I was impressed by the way the young people had identified the situations that might arise, analysed the issues and improvised little dramatised scenes to illustrate what happens. They had clearly picked up the fact that many violent offenders blame the woman for "provoking" them to violence, an excuse which the young people quite rightly did not accept at all.
	The work also helped them to develop strategies for themselves and their fellow pupils to avoid violence and to respond appropriately to it when they came across it or experienced it themselves. The importance of being able to talk to their friends was very high up their list of things that can help. It is very important that we continue to have opportunities in schools for young people to explore these issues.
	The other experience was chairing a seminar for the charity WOMANKIND about violence against women and girls. Two terrific groups of young people from schools many miles apart made a great impression on me. Noble Lords will not be surprised to learn, following the words of my noble kinsman Lord Thomas of Gresford, that one of them was from Wales, where they are ahead of us in many of these issues.
	Both groups were acting as mentors or counsellors about violence and bullying in their own schools. They were girls and boys. Under the guidance of some very committed deputy head teachers, they told us how they worked. They made presentations to the rest of the school at assemblies, they worked through the school council to inform the rest of the school about the issues they had studied and learnt about and they made themselves available as a ready ear for troubled fellow pupils. Because of the guidance and support they had been given, they were able to direct pupils with problems to places where they could get further professional help if necessary. They claimed that their peers were now more likely to confide in them than in a teacher and that they had good training and support and knew what to do if serious matters arose. The whole school was more aware of the problems. Both groups claimed that bullying had decreased in the school, and-this is crucial-that the attitudes and respect of boys towards girls had very much improved. Such schemes have enormous value, and I hope they will continue to be funded. Many of them are funded by voluntary organisations.
	Finally, may I put in a good word for the enormous value of high-quality personal, social, health and economic education in all schools at all levels, age-appropriate of course? All children need, and have a right to, such education to establish and maintain good relationships of all sorts throughout their lives and help them develop self-confidence and healthy attitudes to other people. We in this country are signatories to the UN Convention on the Rights of the Child. Articles 17, 24 and 29 oblige us to provide our children with such education. I hope that the forthcoming curriculum review will give PSHE the importance it deserves and I will continue to lobby Ministers for that.

Baroness Finlay of Llandaff: My Lords, I am grateful to the House for allowing me to speak briefly in the gap in this important and powerful debate initiated by the noble Baroness, Lady Gould. I want to focus on healthcare and a concern as to whether the NHS reforms might inadvertently promote, rather than decrease, abuse blindness in healthcare. We know that one in four pregnant women is abused, that in just under a third of these cases abuse starts in pregnancy and in just over a third of those being abused, abuse worsens in pregnancy. We must recognise child abuse in the womb in policy, because the outcomes for these infants are worse, including an adverse effect on brain development, as the noble Baroness, Lady Walmsley described, an increase in risk of death in the first year of life, and underperformance throughout the rest of child development.
	A study of midwives recently published showed that three-quarters in hospital practice and almost a half in the community had no training in domestic violence, and many had no child protection training. Even when trained, the training effect wears off, so abuse awareness needs to be part of clinical service contracts, with a requirement to ask the question and act on the response, and follow the Welsh example. In that study, although 12 per cent of community midwives encountered definite child abuse, only 2 per cent reported it, leaving a 10 per cent gap between identifying and acting on abuse.
	Double vision requires simultaneously looking at the woman who is being abused and the child. The GP is in a unique position to ask about abuse; such questions are overwhelmingly acceptable to women, particularly those frightened of instigating any action themselves. Children in those households are 30 per cent to 60 per cent more likely to be abused, with poor performance and aggressive and disruptive behaviour.
	Will the quality outcome framework that has changed general practice behaviour be looked at? Have the Government considered using QOF as a way of encouraging GPs prospectively and sensitively to ask about abuse and to signpost support? It has to be tackled at every opportunity.

The Lord Bishop of Ripon and Leeds: My Lords, I, too, am grateful for the permission, and the nudge, to speak in the gap in this debate. I apologise to the House for not having been present for the opening speeches. Had I been able to be here I would have put my name down to speak in this crucial debate on the place of women in our society and on violence against them.
	I want to make three cultural points. The first is to emphasise, as a number of noble Lords have come to do, the danger of secrecy in all this debate and the unwillingness of people to speak about violence against women-that is, those who are the direct victims of violence and those who know about that violence. There needs to be within our culture a much greater willingness to challenge violence against women than I detect at the moment.
	Secondly, religious groups need to be encouraged to be quite clear about their opposition to violence against women and to their willingness to act where there is violence against women. I believe that the record of faiths in this area is not as good as it should be. I should like to encourage all of us, but particularly those with responsibilities within the faith communities of our country, to be still clearer about our opposition to all violence against women.
	One way in which this can happen is through an increasing use of marriage preparation. A large number of young, and not so young, people come to marriage through the offices of the churches and other faith organisations. Our marriage preparation needs to make it still clearer that violence is completely wrong within a marriage relationship.
	On the third of my cultural points, I support strongly what the noble Baroness, Lady Walmsley, said about the need to prevent violence in our homes from the earliest ages of children. I am among those, as many of your Lordships will be, who have signed documents and have been part of the various coalitions under the Children are Unbeatable! tag. The right reverend Prelate the Bishop of Gloucester is another who has signed and has been a part of that movement. I believe that we need to do more in law to stop any form of violence in our homes. I would hope that there might be support from the Minister in pursuing that.
	This is a crucial area. I am pleased to have been given permission to contribute to it, and I look forward very much to the closing speeches and to a sense of direction and purpose in all that has been said today.

Baroness Scotland of Asthal: My Lords, in replying, I declare an interest as patron of the Corporate Alliance Against Domestic Violence, chair of the All-Party Parliamentary Group on Domestic and Sexual Violence, and former chair of the Inter-Ministerial Group on Domestic Violence. I immediately congratulate very warmly my noble friend Baroness Gould on securing this debate and introducing it in such a comprehensive, fluent and informed manner, setting the tone and scope for this debate so that many noble Lords could fly under her wings and explore some vital issues. I also congratulate and thank all those who have participated in this debate so far, before the noble Baroness, Lady Verma, replies. Most of us are very old friends. We have been on this journey for a long time and it is good to see that we are all still here, although perhaps sad that we have not yet expunged violence against women.
	As this debate has demonstrated, this is not an issue on which we have ever divided on party political lines. It is one that unites us in our determination to eradicate domestic violence and every other form of violence against women and young people. That was very much the tone in which we did battle together against this vicious crime during the last Labour Government. We did not hesitate to draw on the wisdom of many in this House, not least the noble Lord, Lord Lester, on forced marriage. We did that without repentance, although I would say to him very gently that he may have forgotten that the initial Bill was all about crime and our issue was that we thought it should be civil.

Lord Lester of Herne Hill: I am sorry to correct the noble and learned Baroness, but that is not quite right. The initial Bill was about harassment; it was never about crime.

Baroness Scotland of Asthal: My Lords, we will differ, but we will absolutely agree that we ended up in just the right place. I also agree with him that that legislation is more than fit for emulation, because it does what is prescribed on the tin. It is very effective, and delicately enables people to have their rights trenchantly supported but in a way that is sympathetic and effective. That is a demonstration of how well we have been able to work together. Noble Lords will remember that, when we first started to work on this issue in a very concentrated way in 2003 and 2004, we were met with some pretty stark statistics, some of which have been referred to already: one in four women, one in six men, 120 women and 20 men dying, and 89 per cent of repeat victimisation being of women.
	The concerted effort that was made by all-those in the Government, those in local government, those in the third sector by individuals-enabled us, together in partnership, to make a strategic change. All of us remembered-and it has rightly been said in this debate-that this was not just a national but an international issue. As the World Health Organisation made clear, domestic violence was the greatest cause of morbidity in women and children globally. That had to be changed.
	In the 13 years of Labour government, that determined action, together with all those who helped us, brought about some real progress. The instance of domestic violence has fallen by 64 per cent since 1997. There was, as the noble Baroness, Lady Stern, has already mentioned, a 54 per cent increase in the number of convictions for rape from 2000 to 2008. Our understanding of the economic cost of domestic violence to our country was stark. Professor Sylvia Walby, as many in this debate will remember, helped us greatly with her assessment in 2004 that the economic cost of domestic violence to our country was £23 billion: £3 billion of which was to public service, £2.7 billion to business, and £17 billion in pain, injury, loss and suffering. The models that we put together, as we have already been told, started in Wales. Cardiff was the launch pad of much of the good practice. However, we learnt that it has to be holistic. Everyone-all departments and entities-had to be involved.
	As a result of that work, when Sylvia Walby went back to assess the cost of domestic violence at the end of 2009 we saw that we had together done something quite remarkable; we had reduced the cost of domestic violence by £7.5 billion. She used exactly the same model, so when it has been said in this debate that the UN identified that we can change violence against women, we know that that is right.
	How did we do it? Many have already mentioned that in this debate: by introducing specialist services such as the specialist domestic violence courts. I absolutely understand that a number of courts are closing, but will the noble Baroness be kind enough to indicate whether any of the courts to close will be domestic violence courts? They have been pivotal in bringing about significant change, as had already been noted.
	There were specialist domestic violence courts, specialist police officers, specialist prosecutors, the independent domestic violence advisers, the independent sexual violence advisers and, really importantly, the MARACs-the multi-agency risk assessment conferences-which enabled us to interdict the violence early, the point made by the noble Baroness, Lady Walmsley. Prevention is far better than cure. The point was emphasised so succinctly in the gap by the noble Baroness, Lady Finlay of Llandaff, who pinpointed the great work that we were able to do on health by helping professionals in the health service to identify and address it in vitro, and thereafter, really making a huge difference.
	We know some of the things that we must do to intervene. We know that rape happens in marriage, and that those who are involved in violence against women often continue that violence outside the home and are a threat to others. The nexus between those two things is of great importance.
	Having commended the Government for continuing their commitment to independent domestic violence, MARACs, the independent sexual violence advisers and the rape referral centres, I ask whether the noble Baroness has any assessment of the changes that will be made in local authority funding. Many of us believe that we are almost at a tipping point. We had the recipe and we were applying it. There was a lot of vigour and we were almost there. I share with the House and the noble Baroness, Lady Verma, who is passionately committed to this area and has been so not only from the moment she sat on the Front Benches opposite but for many years, the view that we may be at risk for some of the reasons touched on by the noble Baroness, Lady Prosser. I am hearing some very worrying issues.
	The noble Baroness and the House will know that last year we saw a helpful decline in the number of people in many of the refuges. They were emptying. It was a downward trajectory. We are now told that that trajectory is going in the opposite direction. One refuge in particular was 100 per cent full and the only place in which a vulnerable woman and her children had to stay was in her car outside a police station, because there was no safer place for her to be. Just a year before, the refuge had had 60 per cent occupancy. It is a worrying indication.
	I asked whether the Corporate Alliance Against Domestic Violence had any further information, and I have been told that right across the country, in the east and the west, it is hearing similar stories. Independent domestic violence advisers are being reduced. The noble Baroness will know that they have been key to prevention, risk assessment and change. In Portsmouth, I am given to understand that there were 10 independent domestic violence advisers, and it looks likely that they will be reduced to three. That pattern is happening all over the country. It has been suggested that the cause is that although local authorities were aware that there should be cuts, many of them had planned for cuts over the whole period of the Parliament, but the burden of frontloading those cuts means that they cannot do what they want to do. I commend the Government on their invitation to local authorities to consider very seriously indeed the consequences of those cuts. Can the noble Baroness say a little more about what she and her Government propose to do to ensure that the changes that we all worked so hard to implement remain in place, because every £1 spent on these services saves at least £6.
	The noble Baroness was asked a further question by the noble Baroness, Lady Howe, and if I may I will ask her a little more. The noble Baroness, Lady Howe, discussed the internet on the sexual exploitation of our children. The noble Baroness will remember that it has been proposed that the Child Exploitation and Online Protection Centre, an organisation that has been praised by everyone, be subsumed into the Serious Organised Crime Agency. Will that in fact happen, bearing in mind that the move has been wholeheartedly condemned by so many, and is there likely to be a rethinking of the issue?
	On trafficking, we would welcome a response from the Government on how they now propose to deal with the directive. The noble Baroness will remember that many on this side of the House fought very hard indeed to encourage the international community to work together on this, so it is a great sadness to us to see that the voice of Her Majesty's Government is not championing the issue right out in front.
	We have had an extremely good debate. I look forward very much to the noble Baroness's answers to the numerous questions that she has been asked, and I should say that I agree with all of them.

Baroness Verma: My Lords, I start by thanking the noble Baroness, Lady Gould of Potternewton, for initiating this important debate and all noble Lords for their valuable contributions. I welcome the fact that we have had a further opportunity to debate this important issue. The noble Baroness, Lady Gould, is a great champion of women and women's issues, and her never-ending energy in ensuring that their voices are heard is to be admired. I have enormous personal respect for the noble Baroness, whom I regard not just as a noble Baroness but as my friend.
	It is unequivocally in the national interest to ensure that women and girls are able to achieve their potential and lead fulfilled lives. We will raise the position of women by promoting equal pay, ending discrimination in the workplace and tackling violence against women and girls both in this country and overseas. This is a key priority for our Government. Violence against women and girls cannot be accepted under any circumstances or for any reasons, yet we continue to see that, in the United Kingdom at least, one in four women will be the victim of domestic abuse and that every year, as has been said, more than 300,000 women are sexually assaulted and 60,000 raped. Internationally, findings in a number of developing countries suggest that violence against women and girls is significant and often endemic. Between 40 and 60 per cent of the women surveyed in Bangladesh, Ethiopia, Peru, Samoa, Thailand and Tanzania said that they had been abused by their immediate partners.
	Our ambition is to end violence. We need to make a real difference to the lives of women and girls who have suffered or are suffering violence. We recognise that it is not a short-term task, and achieving this goal will prove difficult, with barriers and obstacles at every juncture, as we work towards a cultural shift.
	The causes and consequences of violence against women and girls are, of course, extremely complex. For too long, work in this area has focused on the criminal justice response alone. This Government will continue to ensure that the police and courts have the tools that they need to bring offenders to justice and, more importantly, to ensure that victims have the support they need to rebuild their lives. However, this issue cannot be looked at in separate silos, but as a whole.
	We are working across government to prevent and tackle violence against women and girls in the long term, and on 25 November last year we published our approach to how we will achieve this. For the first time, this approach includes our international efforts at bilateral and multilateral levels. To ensure that tackling violence against women and girls remains high on the international agenda, we have appointed Lynne Featherstone as the ministerial champion for tackling violence against women and girls overseas. The Home Office, the Foreign and Commonwealth Office and the Department for International Development are currently finalising plans to support the Minister in this important role.
	We will also continue to promote the empowerment of women worldwide by supporting the newly formed agency UN Women, the implementation of the Convention on the Elimination of All Forms of Discrimination Against Women, and by placing gender equality and empowerment of women at the centre of international development-essential to the achievement of all millennium development goals.
	It is extremely important that continued support for victims is available, particularly in an economic climate that requires us to spend less and yet work more effectively and efficiently. That is why we are determined to move away from the piecemeal funding arrangements of the previous Government. It is why we have allocated £28 million of stable Home Office funding for specialist services over the next four years. That will include the provision of funding and advice to local areas to support independent domestic violence adviser posts, independent sexual violence adviser posts and the role of the multi agency risk assessment conference co-ordinators.
	The allocation includes direct support to voluntary and community sector organisations and I can confirm that the Home Office is currently inviting bids for the next financial year for funding totalling £5 million from services that support victims of domestic abuse and sexual assault. We will also continue to provide direct funding to the national helplines that provide support and advice to all victims of domestic violence, including men.
	We are providing stable funding to those specialist services that have the greatest reach and we are working to ensure that our communications take the information about these services to all communities. Alongside that, we are developing a sustainable funding model to deliver new rape crisis centres across the country and we will provide existing centres with stable and long-term funding.
	Women and girls in every area are being subject to abuse, and local authorities have an important role in ensuring that they are able to overcome the abuse. Despite the difficult economic climate, centrally we have sent out a clear message that violence against women and girls is unacceptable and it is a key priority for us to ensure that we have all our powers working to eliminate it. We will support local areas to deliver the services that their communities need by removing unnecessary targets, ensuring greater local accountability and raising awareness about abuse with front-line professionals.
	The specific issue of funding for refuges is one that has been raised. I must be clear that the allocation of funds for domestic violence provision is a matter for local authorities to determine, based on local needs and priorities. However, throughout the spending review, we have been guided by a commitment to fairness, protecting the most vulnerable people in our society and, as far as possible, protecting front-line services.
	We have secured investment of £6.5 billion for the Supporting People programme over the next four years. Local areas will continue to take decisions informed by local needs in commissioning housing-related support services for victims of domestic violence. The Government are also committed to finding a long-term solution to support women who come to this country on a spousal visa, find themselves a victim of domestic violence and have no recourse to public funds. We will continue to support these women while a more permanent solution is found. We are at the beginning of the work we want to do, at the beginning of a funding cycle in a difficult economic climate. While we will always keep our actions under review, this is our vision and approach for the coming years.
	Law and the application and enforcement of the law are clearly part of what we do. I should like to highlight a number of key points in that area. From June 2011, we will pilot domestic violence protection orders for 12 months in West Mercia, Wiltshire and Manchester. The DVPOs will potentially provide an additional tool for the police in dealing with perpetrators of domestic violence to ensure that the victim has sufficient opportunity to consider her long-term options. We deferred the decision on the pilots so that we could understand their potential impact better and be sure that they would work before committing public funds. We will conduct a full evaluation before we make a decision on national implementation.
	Section 9 of the Domestic Violence, Crime and Victims Act 2004 will bring into law a requirement on local areas to hold a multi-agency review following a case of adult domestic homicide. Domestic homicide reviews are an effective learning and prevention tool for local areas and we are working through the implications of this with our partners before implementing the power. We have committed to introducing this power in spring 2011.
	Since the Forced Marriage (Civil Protection) Act 2007 came into force, we have issued 247 protection orders to protect vulnerable women and men. This is significant, but we know that much more needs to be done. We are committed to raising awareness of forced marriage not only for the individuals concerned but also so that their families and their communities understand that we will take action to prevent young people being forced into marriage against their will. We will also continue to support front-line professionals from schools, children and adult social care, housing, health and police by providing step-by-step advice.
	Another issue of great concern is the lack of prosecutions for female genital mutilation. We have no reason to believe that the Crown Prosecution Service would not be prepared to prosecute if cases were referred to it and there was sufficient evidence to provide a realistic prospect of conviction. Anecdotally, the most likely barrier to prosecution is pressure from the family or wider community to stay silent. However, the Female Genital Mutilation Act 2003 provides a clear message that FGM is an unacceptable practice and illegal in England and Wales. The Act has also been a catalyst for outreach work and has helped to raise awareness of FGM. We will shortly launch new guidelines which will support front-line staff to tackle and prevent the practice, provide support to women and girls and encourage the referral of all suspected cases to the police for investigation.
	Non-molestation and occupation orders can be made under Part IV of the Family Law Act 1996. Such orders are aimed at protecting women from violence or threatened violence, intimidation or harassment. An occupation order can specifically exclude a perpetrator from the family home or surrounding area. Such orders can provide vital protection for victims and their children. It is therefore important to note that the year-on-year rise in applications for non-molestation orders between 2007 and 2009 would appear to contradict suggestions that applicants may be deterred by the possible criminalisation of the respondent since Section 1 of the Domestic Violence, Crime and Victims Act was implemented in July 2007.
	The Sexual Offences Act 2003 was a complete overhaul of the legal framework for dealing with sexual offences and introduced a statutory definition of consent. We know that sexual violence and rape are under-reported crimes and therefore neither prosecuted nor convicted as we would like them to be. There has been some progress. For example, during the four-year period from 2006-07 to 2009-10, the number of rape prosecutions by the CPS rose by 17 per cent from 3,264 to 3,819. But of course we need to do more, and the Government are determined to do more. Our response to the independent review of rape complaints by the noble Baroness, Lady Stern, will help set out our direction for this.
	In October last year we implemented the Equality Act 2010. As part of the Act we are introducing a new public sector equality duty which requires public bodies to consider how their policies meet the needs of all those who use their services. Public bodies will be required to publish data on the impact of their work. This will include relevant data on how they are tackling violence against women and girls and will mean that the public are able to hold them to account.
	I will now try to answer some of the questions put by noble Lords, and if I cannot do so I pledge to write to them. I understand fully the concerns of the noble Baroness, Lady Gould, about prostitution and trafficking being placed in separate strategies but I assure her that it in no way diminishes our determination to address those two particular issues. She is of course absolutely right: it will take a massive cultural shift, not just legislation, for us to be able to ensure that violence against women is on the decrease. We cannot change society and our community actions unless all the partners and actors play their roles within that shift, which we all want to happen.
	The noble Baroness, as well as the noble Baroness, Lady Howe of Idlicote, asked about violence against women and girls being addressed in the teaching in schools. The Government will shortly be announcing a review into personal, social, health and economic education and sexual relationship education. The Department for Education's advisory group will feed into the review part of the coalition Government's commitment to the teaching of sexual consent and healthy relationships in the curriculum-an issue which I think the noble Baroness, Lady Walmsley, raised. Other noble Lords raised the issue of violence against women being addressed in the NHS operating framework. The Department of Health is currently considering the inclusion of violence against women and girls in that framework. Further details of the Government's approach in this area will be included in the violence against women and girls action plan in the spring.
	I am grateful to the noble Baronesses, Lady Massey and Lady Gould, for raising the important issues surrounding trafficking. The Government are committed to working with others, including our European partners, to prevent human trafficking. Our work on trafficking will be taken forward in a separate strategy, as I have already said. In June 2010 the Government decided not to opt into the proposed EU directive on human trafficking, but also to review that position after implementation of the directive. Negotiations on the directive's text were agreed on 13 December, and the directive is scheduled for adoption early next year. If we later conclude that the directive would help us fight human trafficking, we will opt in. I reassure noble Lords that the UK has a very strong record in fighting trafficking and already complies in legislation and practice with most of what is required by the draft directive. The UK will continue to play an active role in helping to improve EU-wide efforts in combating human trafficking.
	I turn to the concerns of the noble Baroness, Lady Walmsley, about the role of better communication in preventing violence against women and girls happening in the first place. This is at the heart of our Government's approach and we are taking steps to ensure that, through the curriculum and our cross-government communication strategy, all avenues are explored in ensuring that we do not fall short. We want to ensure that communications are available to all those who are at the forefront of identifying abuse. We are carefully considering the findings from the independent Munro review of child protection to focus on better supporting child-focused front-line practices. Further detail outlining how this will take place will be published in March. This Government have made a clear commitment to early intervention in the coalition's programme for government, which said that we would investigate a new approach to helping families with multiple problems where violence and abuse can be a risk factor.
	The noble Baroness, Lady Howe of Idlicote, also talked about the sexualisation of children. It is essential that we take steps to challenge these messages, demonstrate that they are not acceptable and work to put positive models and messages in place. That is why the Government have asked Reg Bailey, chief executive of the Mothers' Union, to conduct an independent review into this issue. That will report in May 2011.
	I am now going to try to read my scribbled notes; I apologise. The noble Baroness is right that this is not just going to be a United Kingdom problem-we also have to look at its implications internationally. We take that seriously, and, with our ministerial representative Lynne Featherstone, we hope that at UN Women the issues that we feel strongly about are focused and directed there.
	My noble friend Lord Lester talked about forced marriages. It is a great privilege to have supported the noble Lord and the then Government when that Bill came to this House. I had the privilege of leading from the Conservative Benches. I come from a community where, unfortunately, this practice continues to blight and scar the lives of too many young boys and girls. It is a long and difficult journey to be able to ensure that we are making enough awareness available to those communities to make them see how much of a long-term impact such forced marriages have on young people. Wider than that, it frightens young people away from the prospect of marriage; they feel that they cannot approach their own immediate families to raise their own personal fears. Like the noble Lord, I intend to take every opportunity to endeavour to ensure that this issue is raised, not just in this country. Like the noble Lord, I take it as a personal mission to raise the issue in every country that I visit.
	The Government have committed to providing a full response to the review of the noble Baroness, Lady Stern, into how rape complaints are handled by public authorities in England and Wales. That will be published in the spring alongside the Government's violence against women action plan. The Government's response will highlight the importance of sexual assault referral centres and the role of rape crisis centres. The coalition Government's commitment to supporting those services is outlined in the strategic narrative on violence against women and girls that was published in the autumn. We have already awarded £2.2 million in 2010-11 to improving SARC provision. The Government will shortly announce further funding details for rape crisis centres and SARCs over the spending review period.
	To touch on the "ugly mugs", the Government are currently funding a feasibility study into the development of a national ugly mug scheme. Such a scheme would help to co-ordinate the local schemes currently run by specialist voluntary sector projects. These allow people in prostitution to report information about incidents of violence that they have suffered or provide information about threatening or dangerous clients.
	My noble friend Lady Hamwee raised the issue of the work of the Inter-Ministerial Group on Violence against Women and Girls, which is chaired by the Home Secretary. The Minister for Prisons is currently writing to the Home Secretary to clarify the position of the group and how it will take forward its work on recognising suicide as part of the abuse. I hope we will discuss this at our meeting in February.
	The noble Baroness, Lady Greengross, talked about older women. I thank her for raising this serious but underreported issue. As someone whose business is in care, I understand completely the number of victims that go unreported simply because they do not know where to turn, because their immediate protectors are usually the very people who are carrying out the abuse. I will take that important message back to the department. We need to make sure that it is raised and that we are fully aware of it in our thinking and strategies. Widows are victims who often have the least voice or presence in society. They are often ostracised and abused, and their plights are often simply ignored. Again, it is something that we need to take back and think about more carefully.
	I hope noble Lords will indulge me for one or two more minutes so that I can complete my responses. My noble friend Lord Thomas and the noble Baroness, Lady Finlay, talked about the training of health workers in dealing with violence against women and girls. The Department of Health is currently rolling out training to front-line health practitioners to identify the early signs of violence against women and girls. This is part of the Government's response to the Alberti review and the work of the Department of Health's task force on violence against women and girls. The Government are also exploring how health visitors might have a greater role in identifying the signs of domestic violence in the women they visit. Further details on the training of front-line workers to identify signs of violence in order to intervene early will be outlined in the Government's action plan in March.
	I agree very much with many of the things that the noble Baroness, Lady Prosser, said about there being substantial change, but there is still much to be done. In some communities where it is still acceptable as a norm to beat wives, sisters and daughters, that change is incredibly slow; and because those communities know the abuse will not be reported outside, the abuse will continue. There is a huge mountain to climb. There is no doubt about that.
	The noble Baroness asked about our funding for UN Women. We are undergoing bilateral and multilateral reviews. Until those have concluded, which they should by the spring of this year, it is difficult to comment on funding. However, we are offering transitional support.
	I have been passed a tart note telling me to say that I will write to all noble Lords whom I have not answered. I thank the noble Baroness for initiating this debate.

Baroness Gould of Potternewton: My Lords, I thank everybody who has spoken in this debate, which has been very wide-ranging. One of the things that I always find fascinating about debates like this is how much you learn from other people. The expertise that there is around your Lordships' House has been offered today in this debate. It has shown the breadth of the subject that we are talking about, which makes it more difficult and complicated to solve. Certainly the solutions are in many ways very complex, but I do think these problems are solvable.
	Many noble Lords mentioned the international situation. That is right and may be a subject for another debate, which I would very much appreciate, not least because I have been actively involved with both the UN and the Commonwealth Institute on the question of widows. I would like to have a debate on that subject.
	The noble Baroness, Lady Hamwee, said that this was not just an issue for women. She is perfectly right: it is not just for women but for the whole of society. We have to raise awareness, talk about the issue as much as we can and work to find solutions. I look forward, as I am sure other noble Lords do, to working with the noble Baroness, Lady Verma, to make the strategy work so that we obtain a real solution to this very serious problem. In the mean time, I beg leave to withdraw the Motion.
	Motion withdrawn.

NHS: Front-line and Specialised Services
	 — 
	Debate

Lord Turnberg: To ask Her Majesty's Government what steps they are taking to ensure that the proposed changes to the National Health Service will not damage front-line and specialised services.

Lord Turnberg: My Lords, I suspect that your Lordships may feel that we have had rather a surfeit of debates on the NHS of late, and we have not even seen the Bill yet. However, I am pleased to open this debate as it gives us an opportunity to reflect on what the Minister has said in his previous responses and to try to be constructive in preparing for the Bill.
	I should express my interests again as someone who has spent most of his working life in the NHS as a physician and professor of medicine and then as president of the Royal College of Physicians and more recently as scientific adviser to the Association of Medical Research Charities. I am pleased that the noble Baroness, Lady Jolly, will make her maiden speech in this debate. I very much look forward to hearing what she has to say.
	In our previous debates a large number of criticisms of the White Paper came up, ranging from the wide extent of the proposed changes and whether they were proportionate to the perceived problems of an NHS of which many noble Lords extol the virtues, to a sense that a damaging commercialisation was creeping in. I have to admit that the previous Government were not immune from reorganisation and re-reorganisation zeal but it is significant that it was only when there was a clear increase in funding and a remarkable rise in the number of nurses and doctors that we saw a real improvement in patient care. So while reorganisations may be necessary at times, it is money that talks. At a time when we will be seeing retrenchment in the service, we must ensure that we do not cut these front-line staff.
	I imagine that the Minister is aware of the study carried out by Sir Brian Jarman a few years ago in which he showed that there was a strong negative correlation between the number of doctors in a hospital and the mortality rate in that hospital-the more doctors, the lower the death rate. In that light, are there to be any cuts in the number of trainee doctors in the near future?
	I shall mention three specific topics that impinge on front-line services: the pathfinder consortia; integrated services; and research and teaching. The pathfinders should generate a lot of valuable information. Leaving aside the bias that is introduced by the fact that this is a group of self-selecting enthusiasts who may not represent the generality of somewhat disinterested GPs, the data they will produce should be extremely helpful in deciding which paths to go down and which to avoid. After all, that is what I understand by the term "pathfinder".
	So my questions for the noble Earl are, first, will the Department of Health collect information that will help in the design and size of the generality of consortia when they are rolled out? Secondly, what sort of information will be used in this assessment? Will they be those easy to measure data such as waiting lists or waiting times which at best are relevant only to patients needing cold surgery, such as hip operations, but not relevant to the majority of patients you find in hospitals who are usually brought in as emergencies, such as those with heart attacks, strokes or collapses of various sorts? Or will they try to get information on outcomes that are more meaningful for patients, such as how well they were treated as individuals, how quickly they felt better and whether they got back to work, or whether smoking cessation measures have been more successful, how well alcohol reduction programmes are working and whether all these sorts of outcomes are better under the new arrangements? There is a very welcome emphasis on outcomes in the Government's strategy for cancer, published yesterday. I ask the noble Earl whether a similar approach is intended for the many non-cancer patients faced by the consortia. Many of these outcomes need long-term study, but how else are we going to know whether we are doing any good by these changes. Will the department gather the type of information that can let us know which pathfinders to follow and which to avoid?
	I return to the issue of integrated care that everyone-the royal colleges, the BMA, and the King's Fund-see as the most effective way in which services should be designed and delivered. By integrated care, I mean integration not only across primary care and social services but right across the spectrum, from the community to the secondary care sector where so much of the costs are to be found. You have only to see an elderly patient lingering unnecessarily in an expensive and potentially dangerous hospital bed because of a lack of facilities in the community to recognise the importance of integration of care.
	Problems are due not only to lack of facilities, but are equally likely to be due to poor communication between the two parts of what should be a seamless service. It is patients with complex, multiple diseases, who form the majority and need seamless, joined-up, care across all three sectors. There are plenty of excellent guidelines to best practice for all these types of patients. The guidelines come from the royal colleges, specialist societies, medical research charities and a variety of other organisations. These guidelines are ripe for adoption by consortia for their contracts. One of the problems in the current NHS has been the slow take-up and implementation of good practice guidance. An obvious example is the national service framework for the care of stroke patients, published a decade ago and not yet fully implemented everywhere. What efforts will be made to encourage the spread of good practice, and how will that be incorporated into contracts by consortia? How will consortia use the expertise and knowledge of clinicians in secondary care and of front-line staff in the community sector? They should be working closely together. How will they overcome the potential barriers to this type of collaboration by the competitive environment and the "any willing provider" concept?
	I want to say something about localism and its impact on research. In previous debates, the Minister was reassuringly clear about his commitment to research in the NHS, and the relative protection of the NHS research budget is of course very welcome. I congratulate the noble Earl and Dame Sally Davies for their efforts in achieving this. In this respect, what is to happen to OSCHR, the Office for Strategic Co-ordination of Health Research, the body set up to help co-ordinate research funding between the MRC and the NHS?
	My main concern here is the role of GPs and the consortia in commissioning research and teaching. A recent survey by the Association of Medical Research Charities and Involve found that the vast majority of patients were happy to give consent for the use of their personal data for research, but that few GPs were interested in research, and that even the fairly straightforward business of seeking consent from patients was regarded by many as difficult and too time consuming. Therefore, if GPs are to have a key role in NHS research, it will be vital to give them some sort of incentive for their involvement. I should be very interested in hearing more from the noble Earl about how he thinks we might provide this stimulus.
	Finally on research, I expect that the Minister will have seen the excellent recent report from the Academy of Medical Sciences, commissioned by his department, on the regulation of research. Is it his expectation that the Government will accept the recommendations in the report, particularly those relevant to streamlining regulation?
	I hope I have been a little more constructive today and I look forward to the contributions of other noble Lords and, of course, to the response from the noble Earl.

Lord Colwyn: My Lords, I congratulate the noble Lord, Lord Turnberg, on securing the debate and on his knowledgeable contribution. It was a privilege for me to work with him for a number of years at the Medical Protection Society.
	I am delighted to be so far up the list this afternoon, although I am not sure if it is an advantage. I was given the number 2 slot in the last debate on health on 16 December and failed to excite the Minister with my questions. He has now kindly been in touch to tell me that there is a letter in my box. I am aware of the tremendous pressure that he must be under. I also failed to make an impression at Question Time earlier today and will make a comment on the regulation of herbal practitioners at the end of my few remarks, which will inevitably concern the dental aspects of front-line and specialised services.
	NHS dentistry's place in the health reforms is unusual. As well as being subject to a change in commissioning arrangements, with responsibility for primary care dentistry being transferred from primary care trusts to the new national commissioning board, dentistry will undergo a parallel overhaul of the way it works, with completely new contractual arrangements being developed. This is a pivotal time for NHS dentistry, in which the mistakes of the previous Government's 2006 reforms can be rectified. It will be vital that our reforms engage the dental professionals who will deliver care under the new system, and I am pleased to say that the British Dental Association has offered its broad support to two important parts of the reforms. The decision to transfer responsibility for commissioning from PCTs to the new national commissioning board has been viewed positively by the profession. Given the problems and inconsistencies witnessed under PCT commissioning, that is unsurprising. Dentists have also been positive about the reforms to the dental contract that the coalition Government are undertaking. These reforms build on the work of Professor Jimmy Steele, whose critical report on the current system has produced a vision of a better system. Pilots will begin in April to develop this.
	On the face of it, dentistry looks to have a bright future. The risks inherent in changing systems and commissioning arrangements simultaneously were highlighted by Labour's reforms in 2006, when the ability of PCTs to manage the introduction of the new dental contract was undermined by a reorganisation of primary care trusts that saw their number halved. The success of the coalition Government's reform of dentistry will depend on having the right people in place to manage change at an early stage of the reform process. It will also require a balance to be struck between central commissioning and engaging the local expertise of bodies such as local dental committees and figures such as consultants in dental public health.
	Dental public health is an important issue in its own right, and ensuring that dental public health expertise inputs into new arrangements and is integral to the wider reform of public health will also influence the success of the reform of dental care. This House needs assurance that the Government plan to utilise those local dental experts in the new commissioning arrangements.
	Another lesson we must learn from the 2006 reforms is the importance of properly testing elements of reform. Two major parts of those reforms, the revised patient charges and the system of units of dental activity by which dentists' work is measured, were not piloted in the lead-up to April 2006. As I said, pilots for the new reforms will commence in April. They will test different models that will include patient registration, quality and capitation. The models are intended to lead to a new dental contract that will facilitate a more preventive approach to dental care. The pilots must be given time, they must be properly evaluated and their lessons must be learnt in dialogue with the dental profession.
	The Government will need to tread carefully as they pursue each of these reforms, ensuring that a co-ordinated approach to dentistry is taken across all departments within the Department of Health. They must manage the various strands of reform that will contribute to the creation of new arrangements for primary care dentistry in England. What guarantees will the Minister provide that the work on the three strands that will impact on the delivery of primary dental care-the new contract, public health and commissioning arrangements-will be joined up and co-ordinated?
	I conclude with a question that I was unable to ask earlier today. Will my noble friend offer any encouragement to patients and to the practitioners who use herbal medicine and who regard regulation-as recommended in November 2000 by the Walton committee, of which I was a member, and the Pittilo independent report set up by the Department of Health-as vital to the practice and continuation of their profession?

Baroness Sharp of Guildford: My Lords, I, too, thank the noble Lord, Lord Turnberg, for initiating this timely short debate, and I also look forward to the maiden speech of my noble friend Lady Jolly.
	As most noble Lords will know, it is not usual for me to speak on National Health Service issues. I do not have the detailed knowledge that I have of the education system, but I retain an open mind about the proposed changes. I come from Surrey where we have not had a very happy experience with PCTs. Our PCT has had perennial financial problems of one sort or another. One area with which I have some concern is the future of community hospitals. The decisions they have made have been bad and incredibly vacillating, and have taken far too long. By contrast I have had good experience with my GP practice, and most of my friends are also extremely happy with their GPs. My own practice is very innovative and go-ahead, and I am pleased at the thought that it will have more power.
	Of the reforms, I welcome very much the greater local accountability. We on the Liberal Democrat Benches have long argued for bringing together the responsibilities for health and social care, and a greater role for local authorities. The creation of the health and well-being boards will bring together, within the NHS, both the social care and the related children's care and public health services. That is a very important step in helping to provide us with joined-up health services. I also welcome the focus on patients and their needs. I hope that it will not just be rhetoric. In most cases, patients defer to decisions made by their own GPs or by the consultants they see, but there is a danger that the whole system may be too dominated by professionals and the mentality that professionals know best what to do. It is, therefore, extremely important that we retain within the various boards lay membership at all levels-in the GP consortia and all the way up to the NHS commissioning board.
	Lastly, I welcome the establishment of HealthWatch. I was quite involved at one point with our local community health council and I regretted very much its replacement 10 years back by what struck me as a relatively toothless link committee. I hope that HealthWatch, together with local scrutiny committees, will mean that there is a genuine watchdog for the patient in terms of quality and accountability.
	I have five questions for the Minister. First, precisely what is the role and what will be the powers of the NHS commissioning board? Secondly, where within the system does NICE now fit? I am grateful for reassurances from the Minister at a meeting the other day that NICE will not be abolished, but indeed would be strengthened. However, it would be useful if those reassurances were on the record and he could tell the House how it will fit into the greater scheme of things. Thirdly, I do not understand the trail of accountability in the new system. Who will set the budget for the GP consortia and who will oversee their expenditures? What happens if they overspend? Who holds them to account? With the strategic health authorities now going, who will oversee hospital expenditures and hold them to account if they overspend? While I welcome the bringing together of local public health services with the community and children's health services, will there be enough resources to meet needs given the cuts in local authority funding? Already instances of bed-blocking are reappearing. My noble friend John Shipley raised the issue of bed-blocking in Newcastle with the Minister the other day and there are other instances. As a school governor I have experience of children's and adolescent mental health services and the lack of facilities to provide educational psychologists when they are needed to back up special educational needs provision in schools. Time and again, the NHS has failed to deliver on its responsibilities. How are we to get really effective linking-up between health and local government services?
	Finally, the health and well-being boards will bring together public health and social care services, but one of the traditional problems of the NHS has been the divide between primary and secondary care. What incentives are there within the system to improve that relationship? In particular, there is the relationship between GP care and specialist care. Can the Minister tell us a little more about proposals there? I look forward to hearing the answers that the Minister will give us on those issues.

Baroness Masham of Ilton: My Lords, I thank the noble Lord, Lord Turnberg, for introducing this important debate. It is important because there are so many concerned people who fear, with the spending cuts, that some of their vital specialised services, which are lifelines, may be severed. I hope that the noble Earl can allay some of those fears.
	I must declare an interest, as I am president and founder of the Spinal Injuries Association. There is hardly anything more catastrophic than breaking one's neck and finding that you are paralysed from that point down. It is bad enough breaking one's back, but in all cases there can be complications, and specialised treatment is vital, otherwise complications occur, leading to human suffering and unnecessary costs for the NHS.
	With this huge reorganisation, perhaps there is a chance to improve some front-line services and the specialised services. The White Paper states that patients should be central to the NHS. Are those just words, or will there be action? Will the Government listen to patients, patients' groups, and their doctors? There should be shared decision-making-nothing about me without me.
	We were once the leading country in the world in the treatment of spinal cord injured patients. All of us with an interest in the subject would like that specialty to be returned to its former glory. Doctors, nurses and physiotherapists would come to our national centre from all over the world to train. We are concerned that, already, some expert consultants have retired, and more are to go. Therefore, I ask the Minister a few questions, which perhaps he can answer by letter.
	Are there plans to reinstate spinal cord injury medicine as a speciality or subspecialty? The specialty status was lost in 1995 as a result of the alignment with European regulations. That has resulted in considerable loss of appeal and skills. Are there plans to create a national register, a database, for spinal cord patients? Do the Government know whether current trainees will be able to continue the same services offered by retiring consultants in spinal cord injuries? Is there adequate capacity to meet the readmission needs of spinal cord injured patients to spinal cord injury centres? I do not think so.
	Are your Lordships aware that there are more than 9,000 new cases of tuberculosis in the United Kingdom every year? In the UK, the number of deaths from TB is 1.5 times higher than the number of deaths from HIV/AIDS. London has the highest TB rate of any major capital city in western Europe. Prevention is vital. I consider it a front-line service. The Find & Treat team, which runs the mobile x-ray unit, focuses on screening groups in London with social risk factors, especially the homeless with TB. Homelessness is a risk factor for multidrug-resistant tuberculosis. That underlines the importance of ensuring that complex cases are detected early and supported to successfully complete treatment.
	The emergence of extensively drug-resistant tuberculosis threatens to make the disease untreatable. The Find & Treat team is excellent, and I hope funding can be found so that it can continue its valuable work.
	Childhood cancer and leukaemia are rare conditions that require complex and highly skilled diagnostic and treatment services to achieve the best outcomes. Without specialised, centralised cancer care and excellent front-line local paediatric services, there is a risk that not all children with curable diseases will be cured. These services must be safeguarded, built on and improved.

The Lord Bishop of Gloucester: My Lords, I speak as until recently the chair of the Church of England's Hospital Chaplaincies Council, and, as it happens, the husband of a specialist in palliative medicine and the father of a fairly newly qualified hospital doctor. I believe passionately in the National Health Service and want to see its future secure.
	I share some of the concerns expressed recently by primary care trusts about what might be endangered by their demise and by my own church's response to the Government's proposals through its mission and public affairs council, and I hope these concerns are among the issues that the Minister will want to address. There is time to do little more than list them.
	First, there is in the proposals a risk of losing local intelligence and grip on performance in the management of poorly performing doctors and practices. Secondly, there is a lack of clarity about future commissioning arrangements for learning disability services, mental services and services for other vulnerable groups. Thirdly, the White Paper does not consider what additional GP training might be needed to make effective patient-centred services a reality. In the absence of training and monitoring, it would be all too easy to see the provision of patient-centred services being reduced to a box-ticking exercise. Fourthly, the proposals do not make it clear which services are considered to be front-line services and which are ancillary or administrative. In seeking to cut administrative costs, both commissioners and providers may find themselves under pressure with regard to allied health professionals and chaplaincy services, yet holistic care is essential for good health outcomes; the expertise of allied health professionals and chaplains ought not to be minimised in delivering such care. Fifthly, and perhaps more fundamentally, there is a question about the ability of local authorities to take on new responsibilities in the face of 20 per cent cuts in their own budgets. Linked with this is the complexity of what is proposed, with GP consortia responsible for commissioning healthcare, local authorities receiving an enhanced role in relation to public health and health and well-being boards also having a part to play. The fact that GP consortia and local authorities are not coterminous will make the commissioning process more difficult.
	Alongside these worries, I make two other points very briefly. The first is that for the new arrangements to work, there needs to be rising morale in the health service. That cannot happen while there is a culture that is dismissive of the achievements of recent years. It may well be right, for instance, for PCTs to disappear, but their work does not need to be criticised or rubbished. Unlike the experience of the noble Baroness, Lady Sharp, in Surrey in Gloucestershire where I live and work, the PCT has brought about transformation in infrastructure with new buildings, in finance with historical debts resolved, in health outcomes, for instance in the reduction of teenage pregnancies, and in engagement with clinicians and communities. We need to affirm and honour those who work in the NHS, or else the quality of the health service could trickle through our fingers as morale dips at the same time as difficulty climbs.
	Finally, we need more honesty and realism. Changes are almost bound to damage front-line and specialised services. We have to save money. We have to make choices. We need to accept that not everything can be delivered. If we can start being honest about that, there can be genuine debate about priorities and proper consideration of what can and cannot be achieved. Instead, and this contributes to the collapse of morale, we keep up a pretence that cuts need not damage services and we expect those who work in the NHS to deliver the impossible, but they cannot.

Lord Winston: My Lords, back in November, when I had just come back from cycling around Beijing and seeing at first hand the health service in China, I spoke later that day in a similar debate when the noble Earl, Lord Howe, admonished me for being somewhat acerbic in my comments about the health service. I hope that he has forgiven me, because I think a combination of my jet lag, my passion for the health service-like his passion for the health service, which I greatly respect-and the anxiety that one sometimes feels when speaking from these Benches, and for me the unusual taste of being very briefly on the Front Bench, resulted in my being rather stronger in my remarks than perhaps I should have been. I would, however, like to ask him some questions about the third issue that the noble Lord, Lord Turnberg, has produced in his debate, and I congratulate him on introducing it. May I also say what a pleasure it is to see that the noble Baroness, Lady Jolly, has put her name down to make her maiden speech in this debate? We look forward to hearing her in just a moment.
	Noble Lords must forgive me if I concentrate on hospital medicine, but that is the area I know best. I remember many years ago, from my experience in the United States-when I was a visiting professor in Baltimore and Boston, and later in Texas-that the Americans were very surprised at the massive surgical experience that we could gain in the health service in this country because of the way in which the service was run. We could centralise many specialised services and do very advanced work that was both innovative and useful for research. One issue is that, while this has been more difficult since the introduction of the internal market, there have been at least some attempts to get back to doing exactly that.
	Many aspects are really important for centralisation. First of all, that kind of centralisation is best for some patients with particular needs if they can travel to a service. That often means that they are going to get the best medicine. It is a question not of patient choice but of making sure that they get the best treatment from the most qualified people. Secondly, that kind of centralisation is ideal as a pull for teaching. It is also excellent-indeed, some people would say essential-for training people to make sure that we get the best surgeons. It is a problem that the noble Earl, Lord Howe is very conscious of, given the changes that have happened as a result not of the NHS but of European pressures, which have made things more difficult.
	Centralisation is also important for innovation. The key issue is how these expected changes in the health service will affect our excellence in research. What I really want is reassurance from the noble Earl that the sorts of things that were developed in the health service hitherto will not be difficult to achieve under the current proposals in the White Paper. For example, it seems impossible to imagine that in vitro fertilisation could develop as a research procedure in the structure as proposed. Certainly, during my time at Hammersmith, I saw by-pass surgery, transplant surgery and the cancer smear test being developed, and many other examples of innovative surgery and medicine. Many of the great institutions, such as Great Ormond Street, Hammersmith, and some in Liverpool, Manchester and elsewhere have been made great and international because they have been able to function in a way that it is difficult to see will continue under the structure in this White Paper. I want to make certain that the Minister agrees-I know he does-that the jewel in our crown is the National Health Service. A very special aspect of that, which is internationally recognised, is the unique nature of academic medicine in this country. I would like him to tell us how academic medicine will be protected and will flourish in the structure of the White Paper.

Baroness Jolly: My Lords, I start by thanking noble Lords kindly for the warm welcome that I have found since my introduction on Tuesday-from Members opposite as well as from my own Benches. Advice about my speech was to keep it simple, but most of all to keep it short. I extend these thanks to members of staff who have been exceptionally helpful in all manner of ways. I must say that I am not without trepidation. My introduction by comparison was easy, as once in my robes I was but an actor. Today, I feel somewhat naked without them, particularly in such eminent company.
	I live in Cornwall in a community of some six or seven houses overlooking Bodmin Moor. We have little choice in our services. We use them where we can find them and so rely on them all to be excellent, as the noble Lord, Lord Winston, said. Disappointment is rare. My sponsors, my noble friends Lord Tyler and Lord Teverson, have both left their mark on Cornwall, and I am delighted that today another friend of Cornwall was introduced-my noble friend Lord Marks of Henley-on-Thames. The bottom left-hand corner may be far away, but in this place it will not be forgotten.
	I trained as a control engineer, taught maths for 15 years, and spent time living and working in the Gulf. On coming home, I joined an NHS trust board. Some years later, a couple of NHS reorganisations found me chairing a Cornish PCT and managing a budget of £120 million. Recently, I have been working for Macmillan Cancer Support, a charity dedicated to providing excellent services to those whose lives are affected by cancer, as well as for a campaigning organisation on issues as varied as fuel poverty and survivorship. It was difficult delivering services in such a rural environment, especially ensuring that services are linked as seamlessly as possible with our social services. Not a year went by when we did not have to find savings to be passed on to services.
	In the past, my family has had brief engagements with the NHS, but it was not until last November when my father had a heart attack that I saw the NHS in action for real, for one of mine. One evening, he went to bed feeling unwell. We called NHS Direct. It called an ambulance, which was with us in 15 minutes. After a half-hour dash he was admitted directly to the South West Cardiothoracic Centre in Plymouth. His ECG had been e-mailed ahead by the ambulance crew and he was met by a team called in on a Saturday night. Led by Dr Haywood, his team was professional, caring and candid. The ward really resembled the bridge from the starship "Enterprise", but it was here too that I heard talk of patient dignity and advocacy. My father mattered, as did my mother-a lady who will be 90 on her next birthday.
	Cornwall still has a network of community hospitals that allows patients to be treated nearer their homes, relieves beds in the pressured acute units and prepares patients to return home. In time, at my local community hospital in Launceston, I saw at first hand social services working with the ward team, the physio and occupational therapists. The patient came first and together they got my Dad home. Sadly, the NHS was no match finally for age and frailty. He died one month ago today. We saw the NHS at its finest, from the highest of high-tech medicine to the best of nursing care, working seamlessly across four NHS organisations and social services.
	In the PCT our decisions involved executive directors, non-executive directors and, most importantly, health professionals. We were committed to a comprehensive service that is available to all, free at the point of use and based on need and not on the ability to pay. We took into consideration local issues-rurality, sparcity, atypical demographics and huge population increases in the summer. We did not run or commission services in the same way in Cornwall as they are here in the capital.
	In conclusion, the points made by the noble Lord, Lord Turnberg, are well made. I would add that in reframing the NHS, I trust that the noble Earl will give every care and consideration to service delivery and, more importantly, to appropriate and adequate funding for far-flung remote rural areas, such as Cornwall.

Baroness Finlay of Llandaff: My Lords, I am delighted to follow the noble Baroness, Lady Jolly. I welcome her and congratulate her on having made a superb short maiden speech in the time available. She has shown a deep affection and critical praise of the NHS. She brings to us experience from engineering and maths, and the critical thinking from that, as well as extensive personal, administrative and provision experience in the NHS and the voluntary sector. I am sure the Liberal Democrats celebrate her being on their Benches, and we must celebrate her addition to this House.
	I speak as a clinician in the NHS, and declare all those interests in so doing. The Government have inherited much from the previous Government. They have inherited the problem of the PFI burden, with high interest rates that will increase the burden on hospitals. This will not go away during reorganisation. They have also inherited, as the noble Baroness, Lady Jolly, has illustrated, very high levels of satisfaction with the NHS as we know it. In 2009, indeed, 64 per cent of the population declared themselves to be satisfied or very satisfied. Even among Conservative voters, the figure was 61 per cent.
	The public out there fear the loss of the NHS. They fear the escalating costs that they see in US healthcare. A major concern is the concept of "any willing provider" and its effect on primary and secondary care. The competition engendered by this concept seems to work against collaboration. In private-provider competition there seem to be three main problems. The first one, identified in the US, is fraud. The biggest department in the FBI is that which investigates fraud in healthcare, yet we have US providers advising us. I find that worrying. The second problem concerns the role of Monitor. Will Monitor promote competition? The US system and others show that health outcomes are better where collaboration is higher. I ask the Minister why collaboration between primary and secondary care is not the key marker rather than a pre-requirement to competition. The third problem relates to European law. Current law on services of general intent allow subsidiarity for publicly provided healthcare, but if it is privately provided it will become subject to general interest regulations. If the reorganisation fails, can the service effectively be renationalised?
	I turn briefly to financial failure. Current legislation allows for a failing foundation trust to be brought back into public administration, but that will be repealed. What will happen if a GP consortium runs out of money? Will the patients be left with less or no care? I understand that there is to be a central levy to allow for failure. I ask the Minister how it was calculated, and whether the Government are confident that it will be enough to continue care provision, particularly if faced with multiple failures at the end of the financial year. If a GP consortium fails, will it be taken over by the private sector, as is happening with hospitals?
	The NHS is there for patients. The phrase "nothing about me without me" is both clever and wholly appropriate, referring to clear simple terms of informed consent, but when transposed to choices in healthcare provider it can become distorted rhetoric. The choices that people have to make relate to decisions across all parts of care: whether to remain at home when ill; whether to have a gastrostomy, as swallowing fails in neurological disease; or whether to try physiotherapy to defer joint replacement surgery. There are decisions about immunisation versus infection risks and about how to manage psychotic disease relapse.
	These decisions depend on services being integrated, not operating in isolation or in competition. They require excellence in clinical standards, not just "any willing provider". The problem is that private providers can cherry-pick services to provide in neat packages, but most patients do not fit neat packages. Choice in packages requires a surplus to choose from, but we cannot afford that. Those with complex co-morbidities are optimally managed by a service leading their care and collaborating with others, avoiding duplication and minimising the risk of patients falling into a gap.
	How will secondary care integration with primary care be promoted and long-term planning secured? Patients want choice to be seen by the right person at the right time. Pathfinder consortia may be achieving this in the short term, but if Monitor is to ensure competition, how will such collaboration continue? To ensure data on fair competition, will commercial confidentiality clauses be overturned by statute? How will outcome data be collated? Will they be meaningfully interpreted to account for those with multiple co-morbidities?
	I ask the Minister these questions because we are embarking on a reorganisation that will cost up to £3 billion. There is a genuine fear that an integrated NHS is being dismantled under the influence of for-profit organisations.

Baroness Greengross: My Lords, as chair of the All-Party Group on Dementia, I have a particular interest in dementia care. In my brief remarks, I wish to highlight the potential impact of the changes to those services.
	People with dementia are major beneficiaries of effective joined-up working between health and social care. Can the Minister assure me that any changes in the current coterminosity of boundaries for commissioning health and social care will be appropriately managed for people with dementia?
	One in three people over the age of 65 will die with dementia, and so for many it will be a terminal disease. Why, therefore, is dementia treated, rather than as a health issue like cancer, more as a social ill? In other words, it is more likely to get funding through social care. Thus many dementia patients are obliged to self-fund their care. Is something going to be done to remedy that?
	With the implementation of the national dementia strategy we have witnessed the increasing knowledge and ability of many NHS managers in commissioning for dementia, which is absolutely essential. However, the number of people with these particular skills remains relatively small and it is a concern that the pace of structural change has the potential to undermine this progress. Can the Minister assure me that the valuable dementia commissioning expertise which has been developing recently will be retained in the system?
	Lastly, GPs will in future play an increasingly important role in commissioning services for people with dementia. However, I am concerned that many GPs have too little awareness or knowledge of dementia. For example, when surveyed, only 31 per cent of GPs believed that they had received sufficient basic and post-qualification training to diagnose and manage dementia and only 47 per cent of GPs said that they had sufficient training in dementia management. Only one third of people receive a formal diagnosis of dementia. What will be done to ensure that GPs are fully capable of discharging their new commissioning responsibilities with regard to this absolutely urgent situation? I hope that the noble Earl can respond.

Lord Touhig: My Lords, I am pleased to be here for this debate, if only to have listened to the speech of the noble Baroness, Lady Jolly, because she spoke from the heart about the National Health Service and her family's personal understanding of and reception by the NHS recently. She was also able to speak with some authority as someone who has been involved in the provision of healthcare. I look forward to her future contributions on this matter.
	I am delighted to follow the noble Baroness, Lady Greengross, because I, too, want to relate my remarks to dementia. She does a tremendous job in chairing and leading the all party group.
	If you are a man who has had a stroke and as a result you have no recollection of the wife you have been married to for 30 years, and then you develop dementia, you have no voice. If you are a woman who one day stops talking to her family and has not spoken a word in 18 months, retreating into a valley of silence, you have no voice. If you are a dementia sufferer who is doubly incontinent and you have no downstairs shower and toilet, and the only day of the week when you can be sure that you will be made really clean is the day you go to a healthcare centre, you have no voice. As Parliament, at the behest of the Government, prepares for a major shake-up in the provision of NHS services, I believe that we must be the voice for dementia sufferers and their carers.
	Three-quarters of a million of our fellow citizens have dementia and it is forecast that by 2025 the number will be over a million. I welcome the success of my noble friend Lord Turnberg in securing this debate so we can press the Government to tell us how front-line specialist services will be protected in this shake-up. We currently spend £20 billion a year on dementia and, as the noble Baroness, Lady Greengross, pointed out, one in three people over the age of 65 will die with dementia-yet currently only one in three receives a formal diagnosis. As a member of the Public Accounts Committee in the other place, I well remember a National Audit Office report in 2007 which found that money was being wasted on poor quality care. The report went on to say that rates of diagnosis were low, cost-effective interventions were not widely available, and health and social services were often disjointed and inefficient. A further NAO report this year said that the National Dementia Strategy for England, first published in 2009, was comprehensive and ambitious. It found that there was early progress towards implementation, but warned that not enough priority was being given to dementia. There has been some progress, but not enough.
	I share the worries of the Alzheimer's Society, which is concerned that the pace of structural change that is going to come in the NHS has the potential to undermine the progress we have made so far. That is all the more reason why these changes, as the noble Baroness, Lady Greengross, said, have to be managed very carefully indeed. When I was a Minister in the previous Government, I well remember the former Prime Minister, Tony Blair, saying to me that for him healthcare was not about the doctor, the nurse or the latest high-tech scanner, it was about the patient. Of course, he said, we need the doctor, the nurse and the high-tech scanner, but the focus the whole time must be on the patient-and that, I believe, is right.
	Over the past couple of years, we have seen increasing knowledge and ability among many NHS commissioning managers in commissioning better and improved care for dementia. However, the number of people with these particular skills is relatively small. It is vital, therefore, that the pace of structural change which will come about as a result of the Government's NHS changes does not undermine this progress. Valuable dementia commissioning has been developed and must be retained. Perhaps the Minister can say something about this. GP commissioning will play a major role in the future, but only 31 per cent of GPs believe they have received sufficient basic and post-qualification training to diagnose and manage dementia. Can the Minister say what specific steps the Government will take to ensure that the small pool of dementia care commissioning expertise is not lost, a point well made by the noble Baroness, Lady Greengross?
	A recent survey showed that only 5 per cent of GPs had discussed the national dementia strategy with their PCT commissioners. What is important, therefore, is that the current coterminosity of boundaries for commissioning health and social care is not lost. People with dementia are major beneficiaries of effective joined-up working between the NHS and social care because they use the two services. In order to continue to meet the needs of people with dementia and their carers, can the Minister assure us that the new GP commissioning arrangements will result in a comprehensive primary care response, including improved home care, so that admission to the acute sector is used only where it is necessary?
	We can only imagine what it must be like to suffer with dementia. A dementia sufferer is like a prisoner locked away by an illness of the mind in a world of their own. That is why we must be the voice for those people and their carers.

Lord Kakkar: My Lords, like other noble Lords, I first congratulate the noble Lord, Lord Turnberg, on having secured this important debate and the noble Baroness, Lady Jolly, on a marvellous maiden speech, which was very moving. I also declare my own interest as a clinical academic practising surgeon and my role in the NHS Staff College at University College London Partners.
	The question posed by the noble Lord in this debate is an important one. He asks what steps are currently being taken to ensure that front-line and specialist services are not undermined as we move towards the changes proposed in the forthcoming health Bill. Healthcare systems around the world, particularly mature healthcare systems, are all focusing on the need to improve quality and value, so that the very best clinical outcomes can be achieved for our patients and that these can be achieved in the most effective and cost-efficient fashion so that the valuable resources that the state provides for healthcare are used for the maximum benefit of all in society.
	In that regard, there are four important actions that might be considered in the interim between now and when any changes that are finally agreed when the health Bill passes through this Parliament come into force. The first is in the area of the education of general practitioners and other clinicians in primary care who will have to play a greater role in commissioning. At the moment, there is no specific training for the skills that will be required to ensure that, at the very least, they can supervise and provide the appropriate governance for any commissioning taking place in the environments where they have responsibility in primary care. I ask the noble Earl what arrangements are being made currently to ensure that programmes of continuing professional development start to come into place to provide the skills to those working in general practice to prepare them for the new responsibilities that they will inevitably have if practice-based commissioning goes forward.
	The second is an area that the noble Lord, Lord Turnberg, has alluded to-the whole question of integrated care pathways. These are important. In ensuring that we maximise quality and value in healthcare systems, it is well recognised that a focus on integrated care pathways, particularly for chronic diseases, will be essential. To ensure that we can provide the opportunity for informed commissioning of these services, we need to be certain that metrics that can be used to determine whether the clinical outcomes are successful and are providing best value are developed, assessed and then are available for those who will take commissioning decisions in the future. What arrangements are being made currently to start developing models of integrated care, particularly for chronic diseases? What work is being done to determine the appropriate outcome measures and metrics that might be used to drive commissioning decisions in the future?
	The third area is one of specialist services and in particular the important question that has been raised about the tariffs and the current difference in costs for the provision of specialist services. With the move for responsibility for specialist commissioning to the NHS Commissioning Board, is work currently being undertaken to provide clear definitions of what specialist services will be in the future? For those delivered at regional or supra regional level, what will be expected of these specialist services? Is work being undertaken to determine what costs and tariff base will be required in the future to ensure that these specialist services are not undermined in the changed commissioning arrangements? In particular, will the institutions that provide these specialist services remain sustainable in the altered commissioning environment?
	Finally, I turn to the issue of clinical leadership, one that I have spoken about previously in your Lordships' House. There is no doubt that that this is a major programme of change. It is often said that it is only those who deliver the service who can change the service. Our healthcare professionals, be they doctors, nurses or other healthcare professionals, will not be managed into this change: they will need to be led into it. Winston Churchill said some 60 years ago in a famous speech:
	"Give them the tools and they will finish the job".
	I strongly believe that if we give our healthcare professionals effective clinical leadership, they will indeed deliver for us the change agenda of improving quality and value as well as these changes and those that the previous Government quite rightly focused on, so that we can continue to enjoy a National Health Service of which we are all proud, which delivers the very best healthcare for the people of our country.

Lord Crisp: My Lords, I am grateful to the noble Lord, Lord Turnberg, for giving us an early run at one of the key questions coming out from the Government's proposals-a question which I might rephrase as: will they work where it really matters, at the front line? I, too, congratulate the noble Baroness, Lady Jolly, for giving us such an eloquent description of why they matter.
	There is a great deal to be said for the Government's proposals-not least the continuation of a 20-plus year policy for a primary care-led NHS and for decentralisation, although, as some noble Lords have pointed out, there need to be limits to both of those. There are of course risks. It will be no surprise that I shall concentrate on the more managerial issues. The Minister knows, but I should say for the record, that I was chief executive of the NHS and Permanent Secretary of the Department of Health for six years; so I am afraid that I know a bit about reorganisations and may be seen by some of my clinical friends in the House as one of the villains of the piece.
	I read the Command Paper that came out before Christmas with great interest, particularly where it talked about how to manage the transition. It was well written, as I would expect from former colleagues in the Department of Health, but there were some fundamental gaps that are fundamental risks. I will mention three of them.
	The first is the capability of consortia. I have no doubt that there any many good, talented and skilled GPs and people working in primary care who can and will take the lead in this area. I did not find anything in the paper that described how the capabilities of those consortia to discharge that role would be in any way tested. Your Lordships will no doubt know that foundation trusts and NHS trusts go through a critical scrutiny as to whether they are capable of discharging their functions, and that is to be continued under these proposals. As an NHS trust chief executive 15 years ago, I remember going through just such a tough process where people from outside the organisation tested whether our ambition to do something was matched by reality. The optimism of our will to do it was tested against the pessimism of whether we could actually deliver-were we up to the job? I do not know why that is not being put forward here for GPs unless the Government are too eager to get the GPs involved and do not want to frighten them off at that stage. It is important that some testing is done to secure the success of what is intended here. How will the department test the capability of consortia before they are given free reign?
	Secondly, as a subset of that, I was again interested to know how consortia would be accountable. I see in the text that there is somebody called an accounting officer who is not really defined other than as the person who will account to the NHS commissioning board and then upwards to Parliament for the expenditure of the consortium. It need not be a doctor, we understand, but there is a question about what their responsibilities and powers are. In some ways it looks like going back to the old system of consensus management that we had 25 years ago where you basically had a doctor and an administrator in charge and you had to get the two of them to agree to get any change going. This was the sort of situation of which Roy Griffiths, in a report for the Conservative Government of the 1980s, said that, were Florence Nightingale back today, she would be wandering the corridors of the hospital wondering who was in charge. That question is still there. How will that arrangement work for accountability?
	The third gap, to which my noble friend Lady Finlay alluded, is that these consortia will turn for expertise to private sector organisations, some of which will be from abroad. We know that GPs are saying that, and that it is already happening. They will, for example, turn to people with experience in insurance systems. We have a social contract system: we expect to be able to go to our doctor and know that they will do their best for us, looking at a comprehensive care with some exceptions rather than an insurance system that too often specifies what you can have. There is a big difference between the two. My worry is that there will be a change in the attitude of mind and behaviour in that relationship.
	I have one positive suggestion here which the Minister may or may not like. Although there are pathfinders and there is preparation under way, I have not seen anything that suggests there will be any large-scale simulation of these proposals-getting people together and, over a period, encouraging them to play out the various roles to see what will happen. That has been done in the past, and it is an effective way. The question need not be whether these proposals will work but what you need to do to make sure they work as effectively as possible. Can the noble Earl say whether the Government propose to do any such simulation of these proposals before bringing them fully into effect?

Baroness Meacher: My Lords, I, too, applaud the noble Lord, Lord Turnberg, for initiating this debate. I am sorry that I was not aware of it until rather late in the day, hence my having been slotted into the gap. I must apologise to the House for that. I want to raise two questions which have perhaps received less attention than others. Before doing so, however, I want to set out two examples of the direct implications for services of organisational change. The first concerns the major rationalisation of the acute sector, particularly in London, which was inherited by this Government. The aim of that rationalisation was to reduce the considerable excess supply of hospital beds, particularly in London, in order to make the absolutely essential savings to enable the NHS to balance its books and to improve radically its productivity. These major changes have been put on hold awaiting the completion of the development of the GP consortia arrangements. The failure to make those rationally-argued changes in a timely manner will have direct implications for the funding of front-line services.
	My second example is local. I am not in any way suggesting criticism of the organisation or individuals concerned, but the commissioning changes are already inevitably distracting managers from their day-to-day essential decisions, again with severe adverse consequences. A particular trust with which I am associated, and I declare an interest, has to cut its budget by 4 per cent each year for three years-by £10 million a year. To achieve that, two very significant rationalisations were evaluated and planned, but the PCT's approval is essential before we can go ahead. If those vital savings are delayed-and they are being delayed, as we will not have the PCT decision in time-then we will have to turn away from those well planned changes. The risk is that we will have to make quick cuts on front-line services. Those are my concerns about organisational change and its direct impact on front-line services.
	I have two questions. The first concerns the planned removal of the power of the National Institute for Health and Clinical Excellence to determine whether a specific-

A noble Lord: Two minutes.

Baroness Meacher: Two minutes? I am sorry; nobody warned me about the two minutes. I will very quickly raise the questions. The first is about the power to determine whether a specific drug or treatment may be given under the NHS-I am now completely thrown, but there is a concern about the loss of that power of NICE. The second question concerns the role of Monitor as the regulator and the removal of its compliance framework under the new proposals, as I understand them. It is an excellent provision under the old system, which we are going to lose. I have concerns about that and look forward to the Minister's response.

Baroness Thornton: My Lords, I congratulate my noble friend Lord Turnberg on this debate. Indeed, of all the speakers who have contributed today I particularly welcome the noble Baroness, Lady Jolly, to our debates and our deliberations for the future. I also need to congratulate all the speakers who have contributed today, because we have had a really excellent debate. We probably needed about two or three hours longer than we have had; maybe we need to do that.
	I want to raise two matters, one strategic and one specific. Since June we have debated or had Questions on, among other things, cancer, diabetes, chronic pain, Parkinson's disease, epilepsy, social care, COPD, neurological conditions, dementia and many others. I cannot recall a single debate or Starred Question where the issue of how services would be either safeguarded or delivered under the proposed reforms of the NHS was not raised in one way or another. The Conservative-led Government have been telling us this comforting notion that your family doctor will commission the services that you need-and who better to do so? I am on the record as saying that I support that in principle. However, Conservative MP Sarah Wollaston rather let the cat out of the bag when she wrote in the Guardian on 4 January:
	"I know many GPs who are keen to tackle the redesign of care and even the issue of failing colleagues, but I know none that are interested in EU competition law. If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap".
	I think that that means that private commissioners may turn to private providers at the expense of NHS providers because of the intimidation, or their interpretation, of EU competition law. Will the Minister confirm the role that EU competition law will play in the forthcoming reforms? For example, will GP commissioners be able to choose NHS providers where they offer the best quality and comprehensive service even if they are not the cheapest, without fear of legal challenge from private enterprise cherry-picking the most lucrative contracts? The Minister will know that I have long been a supporter of choice and diversity within the NHS, but the question of how we achieve that might lead to a fundamental dividing line opening up between us.
	The EU competition rules being used as a regulator for NHS services through Monitor provides us with a huge problem. The problem, if I might put it in shorthand, is that health-providing companies owned by shareholders and hedge funds are not independent providers; they are accountable to owners who want to see a profit. So patients and organisations that promote the interests of long-term conditions, for example, are correct to be asking how health services owned and run by these people will have their long-term interests at heart. These are the questions that we will need to answer when we look at the NHS Bill that is promised next week.
	What role does the Minister envisage for the market, for competition and for the private sector as a result of these proposed reforms? Does he believe that collaboration or competition is the best way to run our health service? I promise noble Lords that the noble Baroness, Lady Finlay, and I have not collaborated in asking that question. These are very big issues to which, as I have said, I suspect we need to return for longer and deeper consideration.
	I conclude by raising a specific issue-in many ways, a perfect example of the anxieties that are being raised in all quarters. This concerns GP commissioning and the future of cancer expertise in the new system, and I thank both Cancer Research UK and Macmillan Cancer Support for drawing this to my attention. Before I go on, I add my congratulations to the noble Lords, Lord Crisp and Lord Kakkar, who asked questions that drilled down into the detail that we are going to have to address, as indeed did my noble friend Lord Winston.
	As the Minister will know, the cancer networks have been an absolutely integral and important tool in improving outcomes for cancer patients. The Government have said in the new cancer strategy, Improving Outcomes: A Strategy for Cancer, published yesterday, that cancer networks will continue to be funded during the transition period to GP commissioning. How will GP consortia make use of the expertise currently available in cancer networks to help in the effective commissioning of high-quality and seamless cancer services? How will the Government ensure that the functions currently provided by networks are not lost and standards compromised under the new commissioning regime? Will the Government ensure that cancer networks are funded throughout the transition period until 2014? Will that funding include funding that cancer networks receive from PCTs at the moment as well as directly from the Department of Health? How will GP consortia be incentivised to ensure that the critical functions of cancer networks are still carried out as they commission cancer services?
	I am happy if the Minister wants to write to me about those questions; it is unfair to expect him to answer them in detail at this moment. But they are very important, and I look forward to his remarks.

Earl Howe: My Lords, this has been a wide-ranging and well informed debate. I thank the noble Lord, Lord Turnberg, for calling it and all noble Lords who have spoken so eloquently. It is particularly right that I should single out for special praise my noble friend Lady Jolly, who I am delighted to welcome to your Lordships' House and our health debates.
	The wording of the question that we are debating hints at some nervousness about the Government's reform proposals. I understand and appreciate many of the concerns that have been articulated today. There is, however, one simple truth about the reforms: they are necessary to create a sustainable NHS for the future. To make efficiency savings you have to improve commissioning and address the long-standing problems in a minority of challenged providers. It is for the long-term as well as the short-term future of the health service that we are working, and I remain exceedingly optimistic about that future.
	The Government are fully committed to the NHS and its values and principles. We have prioritised its budget. Total health funding will rise by more than 10 per cent over the spending period. We are also starting to cut spend on administration to focus funding on the front line. The right reverend Prelate voiced some perfectly legitimate concerns about implementing change at a time of financial challenge. I agree with him that the future will see a great deal of change for the NHS. We are not shying away from the difficulties this will present, even within a protected budget. Increasing demands on the NHS mean that we will need to make the budget stretch further than ever before. However, I do not agree that a tighter budget necessarily leads to worse care.
	Our reform agenda is entirely focused on improving the quality of healthcare services. Our vision is to improve health outcomes so that they are among the best in the world, and to bring about a genuine shift in power away from the state and towards the front-line staff and the people who use services. The reforms are designed to lead to better quality and more consistent commissioning so that outcomes for patients improve; drive up the quality of care through patient empowerment and choice; give providers greater freedom to innovate; and create a level playing field with fair pricing, encouraging services to be more responsive to patients' needs.
	There is a clear focus on quality throughout our reforms. To name but a few, there will be payment incentives for quality through the Quality and Outcomes Framework, CQUIN and the tariff. Under the health and social care Bill, which will be introduced shortly, the Secretary of State, the NHS commissioning board and GP consortia will also be required to act with a view to securing continuous quality improvement in services provided by the NHS.
	To achieve optimum outcomes for patients, we are transforming how quality is measured and how the NHS is held to account, shifting the focus away from centrally driven process targets towards improved outcomes, with the NHS held to account against a new NHS outcomes framework. Patient choice is not an end in itself but the focus on choice will drive up the quality of services and therefore improve outcomes. There will be greater access to information and-not least for chronic disease, which was mentioned by the noble Lord, Lord Kakkar-patients should have a greater feeling of empowerment.
	The noble Baroness, Lady Masham, focused on specialised services, particularly for spinal injury. I will write to her on the detail of her questions. We recognised the needs of patients for specialised services when we drew up the reform programme last summer. Patients accessing specialised services should receive high-quality, effective, evidence-based treatment and care with improved outcomes. Our proposal is that the NHS commissioning board should commission specialised services. Responses to the public consultation have generally supported this proposal. However, the system will allow for flexibility in who commissions which services, allowing for changes over time as needed.
	The noble Lord, Lord Kakkar, asked me about definitions. There will be the flexibility to change the definition of specialised services so that more or fewer services are commissioned by the board. This will allow the system to align with changing patterns of care. Additionally, there will be flexibility for consortia to decide how to commission other low-volume services; for example, by federating together.
	The key point here is that we recognise that there is no one size fits all organisational structure that will work for all services equally. Therefore, we are moving away from specifying a fixed number of local or regional commissioning bodies to create a much more flexible structure where consortia can grow or shrink and can work together and with the NHS commissioning board in order to commission high-quality care most effectively. I say to the right reverend Prelate in particular that we will maintain our focus on the quality of care throughout the transition to the new system. Transition will occur through a carefully designed and managed process allowing for rapid adoption, system-wide learning and effective risk-management. We are determined fully to support the NHS during these changes.
	The noble Lord, Lord Turnberg, asked me some specific questions about whether there were to be any cuts in the number of trainee doctors. The number of trainee doctors should be appropriate to meet the estimates of future demand for trained doctors. This year the entry to postgraduate medical training will be around 6,800 in total. That is in line with the recommendations from the Centre for Workforce Intelligence report on 2011 training numbers that analysed trainee doctor intakes in the context of long-term demand for consultants. The Centre for Workforce Intelligence will continue to provide that kind of analysis to us. The noble Lord asked about GP pathfinders. We are engaging with the first group of pathfinders to consider some of the very questions that he posed. We will be hosting a learning event for pathfinders later this month to explore those issues and to showcase the early impact of emerging consortia. It will be the responsibility of the NHS commissioning board to produce and publish an analysis of the findings of the pathfinder programme and set out the lessons learnt but we are also setting up a learning network to ensure that the experience of pathfinders can be quickly shared through the wider GP community. The learning from the pathfinders will touch on both the areas that the noble Lord raised. One will be to look at some of the structural principles such as the successes and obstacles that consortia of different sizes come up against. But we want pathfinders to start making a difference for their patients now, and so improving services for patients is the area into which pathfinders will be putting most of their efforts.
	The noble Lord also raised the issue of integrating care and the spread of good practice and how that will be incorporated into contracts. One of the key roles of the board will be to provide national leadership for driving up the quality of care. I say that also to the noble Baroness, Lady Sharp, who asked me about this. It will help spread best practice by publishing commissioning guidance and model care pathways based on the evidence-based quality standards that it has asked NICE to develop. It will develop model contracts and standard contractual terms for providers. It will also develop the commissioning outcomes framework. I could go on about more areas of support that consortia will get from the board but I hope this reassures the noble Lord that our reforms will mean that good practice is embedded far more widely and more quickly than it is in the current system.
	The noble Lord asked how the expertise and knowledge of clinicians in secondary care would be built into this process. That was an issue raised also by the noble Baroness, Lady Sharp, and, in a different way, by the noble Lord, Lord Touhig, in relation to dementia care. It was also alluded to by the noble Lord, Lord Kakkar. We have consistently emphasised the importance of multi-professional involvement in commissioning and we expect that this will be one of the areas that will be examined as part of the pathfinder programme. Good commissioning and the designing of care pathways will naturally involve a wide range of professionals and we would expect GP consortia to engage other health and care professionals in their commissioning work. Incidentally, I say to the noble Lord, Lord Kakkar, that we will continue to support the previous Government's programme of integrated care pilots.
	The noble Baroness, Lady Sharp, asked me how health and local government services will be joined up. For the first time local authorities will have a lead role in improving the strategic co-ordination of commissioning across the NHS, social care and related children's and public health services. The new health and well-being boards will bring together the key leaders across these services to work in partnership and to develop a joint health and well-being strategy for their area. I hope that that partly reassures her that the services she particularly mentioned will certainly not be lost sight of in that process, because there is a fundamental synergy in the structures that I have referred to.
	The noble Lord, Lord Turnberg, asked what is to happen to OSCHR, the Office for Strategic Co-ordination of Health Research. It has done a fine job over the past three years. It is a very useful mechanism for facilitating processes for joint working, focusing particularly on translational research. That body will continue with an increased focus on co-ordination and foresight.
	The noble Lord also asked how GP consortia will be incentivised to be involved in health research. I recognise his concerns. There is not time for me to say a lot, but the department is funding the National Institute for Health Research Primary Care Research Network. This brings together a wide range of primary care health professionals and is dedicated to expanding clinical research in primary care. The Academy of Medical Science's report, which the noble Lord referred to, was published this week. We welcome the report and we are carefully considering how to implement its recommendations. I will write to him further on that.
	The noble Lord, Lord Winston, asked in particular about how academic medicine will be protected. The Government recognise the crucial importance of academic medicine; we are increasing funding for health research, as has been mentioned, part of which supports lectureships and other awards, and we are currently consulting on our proposals for education and training. However, again, perhaps I may write to the noble Lord with further and better particulars.
	My noble friend Lord Colwyn spoke on his specialist subject of dentistry, and perhaps I can make some amends for my previous omissions on this score. The Government are committed to piloting the new contracts before introducing any of them at scale, to ensure that lessons are learnt and acted on. The design and introduction of a new contract will be a key part of the piloting process. The BDA has welcomed that. Representatives from the profession have been closely involved in the work to develop our proposals. The intention is for the National Health Service commissioning board to commission secondary care to ensure consistency of approach. Again, time prevents me answering some of his further questions.
	On herbal medicine and the possible regulation of authorised practitioners, I cannot go much further than I did in my earlier Answer to the noble Lord, Lord Pearson, other than to acknowledge my noble friend's rightful concerns and to re-emphasise that we are taking our deliberations forward as a matter of urgency.
	The noble Baroness, Lady Sharp, asked who will oversee hospital expenditure. The answer is that that will be done by governors in foundation trusts, who will scrutinise trust board expenditure. She also asked me about NICE, as did the noble Baroness, Lady Meacher. NICE is recognised as an international leader in the evaluation of drugs and health technologies and will continue to have an important advisory role, including assessing the incremental therapeutic benefits of new medicines. However, as we implement our plans for value-based pricing from 2014-a little way ahead-NICE's role will inevitably evolve. Its work will increasingly focus on giving authoritative advice to clinicians on how to deliver the most effective treatments and on the development of quality standards.
	I am conscious that I have overshot my time. Although there is technically time in hand, it would not be courteous to the House if I continued. I have many further answers and I apologise to noble Lords whose questions I have not reached. I will write to them as fully as I can. I apologise in particular to the noble Baroness, Lady Finlay, whose questions I was very keen to answer.
	I recognise that these reforms will be undertaken in a challenging context in which staff and leaders across the NHS face personal and professional uncertainty about their futures. However, the enthusiasm shown by commissioners, providers, managers and clinicians to bring the new system into being makes me certain that success is achievable.

National Insurance Contributions Bill
	 — 
	First Reading

The Bill was brought from the Commons, read a first time and ordered to be printed.
	House adjourned at 6.05 pm.